What is Invisible Support?


In psychology, invisible support is a type of social support in which supportive exchanges are not visible to recipients.

There are two possible situations that can qualify as acts of invisible support. The first possibility entails a situation where “recipients are completely unaware of the supportive transaction between themselves and support-givers”. For example, a spouse may choose to spontaneously take care of housework without mentioning it to the other couple-member. Invisible support also occurs when “recipients are aware of an act that takes place but do not interpret the act as a supportive exchange”. In this case, a friend or family member may subtly provide advice in an indirect manner as a means to preserve the recipient’s self-esteem or to defer his or her attention from a stressful situation. Invisible support can be viewed on both ends of an exchange, in which the recipient is unaware of the support received and the provider enacts support in a skilful, subtle way.


It is known that perceptions of social support availability predict better adjustment to stressful life events; it has been found that the perception of support availability is inherently comforting, and can serve as a psychological safety-net that motivates self-reliant coping efforts in the face of stress. Although the perception of support availability is associated with better adjustment, the knowledge that one has been the recipient of specific supportive acts has often been unhelpful to effectively reduce stress. The knowledge of receiving help may come at a cost with decreased feelings of self-esteem and self-efficacy, because it increases recipients’ awareness towards their personal difficulties to manage stressors. People’s well-intentioned support attempts may also be miscarried, and their efforts could either fail or even worsen the situation for a person under stress. Since supportive acts benefit recipients but their actual knowledge of receiving support is sometimes harmful, it has been theorised that the most effective support exchange would involve one in which the provider reports giving support but the recipient does not notice that support has occurred. From a cost-benefit point of view, invisible support would be optimal for the recipient because the benefits of provision are accrued while the costs of receipt are avoided. Using the same idea, it also implies that the least effective type of support would be one in which the provider does not report providing support but the recipient reports receiving it.

The first investigation of invisible support involved a couples study in which one member was preparing for the New York State Bar Exam. Support receipt and provision were measured by having both couple members complete daily diary entries. Over the course of one month, stressed individuals who reported low frequency of received support (but whose partner ranked their own actions as highly supportive) rated themselves low on anxiety and depression compared to other individuals who reported high frequency of received support.

Compared to Visible Support

A substantial body of work has evidence to suggest that support is most effective when it is invisible or goes unnoticed by recipients. While invisible support has been shown to benefit recipients over visibly supportive acts in some cases, there have also been instances where recipients have benefitted from visible support as well. For example, greater observed support enacted by intimate partners during couples’ support-relevant exchanges have been shown to build feelings of closeness and support, boost positive mood and self-esteem, and foster greater goal achievement and relationship quality across time.

It has been recently suggested that acts of invisible support and visible support may be beneficial or costly depending on different circumstances. To investigate this idea, a recent study in 2013 compared the short-term and long-term effects of visible and invisible support reception during romantic couples’ discussions of each partner’s personal goal. It was found that either type of support was more beneficial depending on the emotional distress that recipients felt at the time. Visible emotional support (support through reassurance, encouragement, and understanding) was associated with perceptions of greater support and discussion success for recipients who felt greater distress during the discussion. In contrast, invisible emotional support was not associated with recipients’ post-discussion perceptions of support or discussion success. For long-term support effects, it was found that only invisible emotional support predicted greater goal achievement across the following year.

When put together, these findings suggest that visible support and invisible support have unique functions for well-being. When people are under distress, visible support appears to be a short-term remedy to reassure recipients that they are cared for and supported. These benefits are only present when recipients are actually distressed during the time that the supportive act takes place. On the other hand, while invisible support tends to go unnoticed by recipients, it seems to play an integral role in the long-term success of goal-maintenance. This increasingly complex view of the implications of support visibility is reinforced by a growing body of research suggesting the effects of invisible social support – as with visible support – are moderated by provider, recipient, and contextual factors such as recipients’ perceptions of providers’ responsiveness to their needs, or the quality of the relationship between the support provider and recipient.

Effects on Support Providers

Refer to Social Support, Psychology, Stress (Psychological; Eustress and Distress), Coping (Psychology), Self-Esteem, and Self-Efficacy.

The effects of invisible support on recipients have been extensively investigated, but the consequences of invisible support on providers are less known. One study in 2016 investigated the benefits and costs of invisible support on couple-members who enacted supportive behaviours by differentiating the processes of invisible emotional support (support through reassurance, encouragement, and understanding) from processes of invisible instrumental support (providing tangible aid such as sending money or childcare). No costs of support-giving were found for providers when they demonstrated acts of invisible emotional support. The effects for invisible instrumental support told a different story, where providers who reported high relationship satisfaction were unaffected, but providers who reported low relationship satisfaction were negatively affected by their acts of invisible instrumental support with an increase in negative mood. These findings suggest that emotional comfort may be a more central function to maintain close relationships than instrumental support. Therefore, providing invisible emotional support may lead to less perceptions of a costly inequity than providing invisible instrumental support on average. However, since invisible instrumental support did not incur costs for providers who reported high relationship satisfaction, it implies that high relationship satisfaction may buffer potential costs that would otherwise be felt by support-providers. The differential results between invisible instrumental and emotional support indicate that a solid distinction between instrumental and emotional social support may be useful to take into account when investigating effects of invisible support as a whole.

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What is Health Realisation?


Health realisation (HR) is a resiliency approach to personal and community psychology first developed in the 1980s by Roger C. Mills and George Pransky, and based on ideas and insights these psychologists elaborated from attending the lectures of philosopher and author Sydney Banks. HR first became known for its application in economically and socially marginalised communities living in highly stressful circumstances (refer to Community Applications below).

HR focuses on the nature of thought and how it affects one’s experience of the world. Students of HR are taught that they can change how they react to their circumstances by becoming aware that they are creating their own experience as they respond to their thoughts, and by connecting to their “innate health” and “inner wisdom.”

HR also goes under the earlier name of “Psychology of Mind” and most recently “Three Principles” understanding.

The Health Realisation Model

In the Health Realisation (“HR”) model, all psychological phenomena, from severe disorder to glowing health, are presented as manifestations of three operative “principles” first formulated as principles of human experience by Sydney Banks:

  • Mind – the universal energy that animates all of life, the source of innate health and well-being.
  • Consciousness – the ability to be aware of one’s life.
  • Thought – the power to think and thereby to create one’s experience of reality.

“Mind” has been likened to the electricity running a movie projector, and “Thought” to the images on the film. “Consciousness” is likened to the light from the projector that throws the images onto the screen, making them appear real.

According to HR, people experience their reality and their circumstances through the constant filter of their thoughts. Consciousness makes that filtered reality seem “the way it really is.” People react to it as if this were true. But, when their thinking changes, reality seems different and their reactions change. Thus, according to HR, people are constantly creating their own experience of reality via their thinking.

People tend to experience their reality as stressful, according to HR, when they are having insecure or negative thoughts. But HR suggests that such thoughts do not have to be taken seriously. When one chooses to take them more lightly, according to HR, the mind quiets down and positive feelings emerge spontaneously. Thus, HR also teaches that people have health and well-being already within them (in HR this is known as “innate health”), ready to emerge as soon as their troubled thinking calms down. When this happens, according to HR, people also gain access to common sense, and they can tap into the universal capacity for creative problem solving or “inner wisdom.” Anecdotal reports suggest that, when a person grasps the understanding behind HR in an experiential way, an expansive sense of emotional freedom and well-being can result.

Health Realisation as Therapy

In contrast to psychotherapies that focus on the content of the clients’ dysfunctional thinking, HR focuses on “innate health” and the role of “Mind, Thought, and Consciousness” in creating the clients’ experience of life.

The HR counsellor does not attempt to get clients to change their thoughts, “think positive”, or “reframe” negative thoughts to positive ones. According to HR, one’s ability to control one’s thoughts is limited and the effort to do so can itself be a source of stress. Instead, clients are encouraged to consider that their “minds are using thought to continuously determine personal reality at each moment.”

HR characterizes feelings and emotions as indicators of the quality of one’s thinking. Within the HR model, unpleasant feelings or emotions, or stressful feelings, indicate that one’s thinking is based on insecurity, negative beliefs, conditioning or learned patterns that are not necessarily appropriate to the live moment here and now. They simultaneously indicate that the individual has temporarily lost sight of what HR asserts is his or her own role in creating experience. Pleasant or desired feelings (such as a sense of well-being, gratitude, compassion, peace, etc.) indicate, within the HR model, that the quality of one’s thinking is exactly as it needs to be.

HR holds that the therapeutic “working through” of personal issues from the past to achieve wholeness is unnecessary. According to the HR model, people are already whole and healthy. The traumas of the past are only important to the extent that the individual lets them influence his or her thoughts in the present. According to HR, one’s “issues” and memories are just thoughts, and the individual can react to them or not. The more the clients’ experience is that they themselves are creating their own painful feelings via their own “power of Thought,” HR suggests, the less these feelings bother them. Sedgeman has compared this to what happens when we make scary faces at ourselves in the mirror: because we know it is just us, it is impossible to scare ourselves that way.

Thus HR deals with personal insecurities and dysfunctional patterns almost en masse, aiming for an understanding of the “key role of thought”, an understanding that ideally allows the individual to step free at once from a large number of different patterns all connected by insecure thinking. With this approach, it is rare for the practitioner to delve into specific content beyond the identification of limiting thoughts. When specific thoughts are considered to be limiting or based on insecurity or conditioning, the counsellor encourages the individual to disengage from them.


From the perspective of HR, relationship problems result from the partners’ low awareness of their role in creating their own experience via thought and consciousness. Partners who respond to HR reportedly stop blaming and recriminating and react to each other differently. HR counsellors aim to get couples to consider that each one’s own feelings are not determined by one’s partner and that the great majority of issues that previously snarled their interactions were based on insecure, negative, and conditioned thinking. HR counsellors further suggest that every person goes through emotional ups and downs and that one’s thinking in a “down” mood is likely to be distorted. HR teaches that it is generally counterproductive to try to “talk through” relationship problems when the partners are in a bad mood. Instead HR suggests that partners wait until each has calmed down and is able to discuss things from a place of inner comfort and security.

Chemical Dependency and Addiction

HR sees chemical dependency and related behaviours as a response to a lack of a sense of self-efficacy, rather than the result of disease. That is, some people who are, in HR terms, “unaware” of their own “innate health” and their own role in creating stress via their thoughts turn to alcohol, drugs, or other compulsive behaviours in the attempt to quell their stressful feelings and regain some momentary sense of control. HR aims to offer deeper relief by showing that negative and stressful feelings are self-generated and thus can be self-quieted and it seeks to provide a pathway to well-being that does not depend on external circumstances.

Community Applications

The Health Realisation (“HR”) model has been applied in a variety of challenging settings. An early project, which garnered national publicity under the leadership of Roger Mills, introduced HR to residents of a pair of low-income housing developments in Miami known as Modello and Homestead Gardens. After three years, there were major documented reductions in crime, drug dealing, teenage pregnancy, child abuse, child neglect, school absenteeism, unemployment, and families on public assistance. Jack Pransky has chronicled the transformation that unfolded there, in his book Modello, A Story of Hope for the Inner City and Beyond.

Later projects in some of the most severely violence-ridden housing developments in New York, Minnesota, and California and in other communities in California, Hawaii, and Colorado built upon the early experience in the Modello/Homestead work. The Coliseum Gardens housing complex in Oakland, California, for example, had previously had the fourth highest homicide rate of such a complex in the US, but after HR classes were launched, the homicide rate began to decline. Gang warfare and ethnic clashes between Cambodian and African-American youth ceased. In 1997, Sargeant Jerry Williams was awarded the California Wellness Foundation Peace Prize on behalf of the Health Realisation Community Empowerment Project at Coliseum Gardens. By the year 2006, there had been no homicides in the Complex for nine straight years.

The HR model has also found application in police departments, prisons, mental health clinics, community health clinics and nursing, drug and alcohol rehabilitation programmes, services for the homeless, schools, and a variety of state and local government programmes. The County of Santa Clara, California, for example, has established a Health Realisation Services Division which provides HR training to County employees and the public. The Services Division “seeks to enhance the life of the individual by teaching the understanding of the psychological principles of Mind, Thought and Consciousness, and how these principles function to create our life experience,” and to “enable them to live healthier and more productive lives so that the community becomes a model of health and wellness.” The Department of Alcohol and Drug Services introduced HR in Santa Clara County in 1994. The Health Realisation Services Division has an approved budget of over $800,000 (gross expenditure) for FY 2008, a 41% increase over 2007, at a time when a number of programmes within the Alcohol and Drug Services Department have sustained budget cuts.

HR community projects have received grant funding from a variety of sources. For example, grant partners for the Visitacion Valley Community Resiliency Project, a five-year, multimillion-dollar community revitalisation project, have included Wells Fargo Bank, Charles Schwab Corporation Foundation, Charles and Helen Schwab Foundation, Isabel Allende Foundation, Pottruck Family Foundation, McKesson Foundation, Richard and Rhoda Goldman Fund, S.H. Cowell Foundation, San Francisco Foundation, Evelyn & Walter Haas, Jr. Fund, Milagro Foundation, and Dresdner RCM Global Investors. Other projects based upon the HR approach have been funded by the National Institute of Mental Health, the US Department of Justice, the National Institute on Drug Abuse, the California Wellness Foundation, and the Shinnyo-en Foundation.

Ongoing community projects organised by the Centre for Sustainable Change, a non-profit organisation founded by Dr. Roger Mills and Ami Chen Mills-Naim, are funded by the W.K. Kellogg Foundation. The Centre for Sustainable Change works in partnership with grassroots organisations in Des Moines, Iowa; Charlotte, North Carolina; and the Mississippi Delta to bring Three Principles training to at-risk communities under the umbrella of the National Community Resiliency Project. The Centre also works with schools, agencies and corporations.

Organisational Applications

From the original applications, as people in the business world have been introduced to HR or the “Three Principles” (as the core understanding is known), they have started to bring these ideas into the business world they have come from. The approach has been introduced to people in medicine, law, investment and financial services, technology, marketing, manufacturing, publishing, and a variety of other commercial and financial roles. It has been reported anecdotally to have had significant impact in the areas of individual performance and development, teamwork, leadership, change and diversity. According to HR/Three Principles adherents, these results flow naturally as the individuals exposed to the ideas learn how their thoughts have been creating barriers to others and barriers to their own innate creativity, common sense, and well being. As people learn how to access their full potential more consistently, HR adherents say, they get better results with less effort and less stress in less time.

Two peer-reviewed articles on effectiveness with leadership development were published in professional journals in 2008 (ADHR) and 2009 (ODJ):

  • C.L. Polsfuss & A.Ardichvili, “Three Principles Psychology: Applications in Leadership Development & Coaching”, Advances in Developing Human Resources Journal, 2008; 10; 671 doi:10.1177/1523422308322205. Online article at: http://adh.sagepub.com/cgi/content/abstract/10/5/671.
  • C.L. Polsfuss & A.Ardichvili, “State of Mind as the Master Competency for High-Performance Leadership”, Organizational Development Journal, Volume 27, Number 3, Fall 2009.

Philosophical Context

Health Realisation (“HR”) rests on the non-academic philosophy of Sydney Banks, which Mr. Banks has expounded upon in several books. Mr. Banks was a day labourer with no education beyond ninth grade (age 14) in Scotland who, in 1973, reportedly had a profound insight into the nature of human experience. Mr. Banks does not particularly attempt to position his ideas within the larger traditions of philosophy or religion; he is neither academically trained nor well read. His philosophy focuses on the illusory, thought-created nature of reality, the three principles of “Mind”, “Thought”, and “Consciousness”, the potential relief of human suffering that can come from a fundamental shift in personal awareness and understanding and the importance of a direct, experiential grasp of these matters, as opposed to a mere intellectual comprehension or analysis. Mr. Banks suggests that his philosophy is best understood not intellectually but by “listening for a positive feeling;” and a grasp of HR is said to come through a series of “insights,” that is, shifts in experiential understanding.

Teaching of Health Realisation

Health Realisation (“HR”), like Sydney Banks’s philosophy, is deliberately not taught as a set of “techniques” but as an experiential “understanding” that goes beyond a simple transfer of information. There are no steps, no uniformly appropriate internal attitudes, and no techniques within it. The “health of the helper” is considered crucial; that is, trainers or counsellors ideally will “live in the understanding that allows them to enjoy life,” and thereby continuously model their understanding of HR by staying calm and relaxed, not taking things personally, assuming the potential in others, displaying common sense, and listening respectfully to all. Facilitators ideally teach in the moment, from “what they know” (e.g. their own experience), trusting that they will find the right words to say and the right approach to use in the immediate situation to stimulate the students’ understanding of the “Three Principles”. Rapport with students and a positive mood in the session or class are more important than the specific content of the facilitator’s presentation.

Evaluations of Health Realisation

A 2007 peer-reviewed article evaluating the effectiveness of HR suggests that the results of residential substance abuse treatment structured around the teaching of HR are equivalent to those of treatment structured around 12-step programmes. The authors note that “these results are consistent with the general findings in the substance abuse literature, which suggests that treatment generally yields benefits, irrespective of approach.”

A small peer-reviewed study in preparation for a planned larger study evaluated the teaching of HR/Innate Health via a one-and-a-half-day seminar, as a stress- and anxiety-reduction intervention for HIV-positive patients. All but one of the eight volunteer participants in the study showed improved scores on the Brief Symptom Inventory after the seminar, and those participants who scored in the “psychiatric outpatient” range at the beginning of the seminar all showed improvement that was sustained upon follow-up one month later. The study’s authors concluded that “The HR/IH psychoeducational approach deserves further study as a brief intervention for stress-reduction in HIV-positive patients.”

A 2007 pilot study funded by the National Institutes of Health evaluated HR in lowering stress among Somali and Oromo refugee women who had experienced violence and torture in their homelands, but for whom Western-style psychotherapeutic treatment of trauma was not culturally appropriate. The pilot study showed that “the use of HR with refugee trauma survivors was feasible, culturally acceptable, and relevant to the participants.” In a post-intervention focus group, “many women reported using new strategies to calm down, quiet their minds and make healthier decisions.” Co-investigator Cheryl Robertson, Assistant Professor in the School of Nursing at the University of Minnesota, was quoted as saying, “This is a promising intervention that doesn’t involve the use of highly trained personnel. And it can be done in the community.”

The Visitacion Valley Community Resiliency Project (VVCRP) was reviewed by an independent evaluator hired by the Pottruck Foundation. Her final report notes that “Early program evaluation…found that the VVCRP was successful in reducing individuals’ feelings of depression and isolation, and increasing their sense of happiness and self-control. The cumulative evaluation research conducted on the VVCRP and the HR model in general concludes that HR is a powerful tool for changing individuals’ beliefs and behaviours.” In the Summary of Case Studies, the report goes on to state, “The VVCRP was effective over a period of five years of sustained involvement in two major neighbourhood institutions…at influencing not just individuals, but also organisational policies, practices, and culture. This level of organisational influence is impressive when the relatively modest level of VVCRP staff time and resources invested into making these changes is taken into account. The pivotal levers of change at each organisation were individual leaders who were moved by the HR principles to make major changes in their own beliefs, attitudes, and behaviours, and then took the initiative to inspire, enable, and mandate similar changes within their organisations. This method of reaching “critical mass” of HR awareness within these organisations appears to be both efficient and effective when the leadership conditions are right. However, this pathway to change is vulnerable to the loss of the key individual leader.”

Research Efforts on Effectiveness

Pransky has reviewed the research on HR (through 2001) in relation to its results for prevention and education, citing about 20 manuscripts, most of which were conference papers, and none peer-reviewed journal articles, although two were unpublished doctoral dissertations. (Kelley (2003) cites two more unpublished doctoral dissertations.) Pransky concludes:

“Every study of Health Realization and its various incarnations, however weak or strong the design, has shown decreases in problem behaviors and internally experienced problems. This approach appears to reduce problem behaviors and to improve mental health and well-being. At the very least, this suggests the field of prevention should further examine the efficacy of this … approach by conducting independent, rigorous, controlled, longitudinal studies….”


In a criticism of the philosophy of Sydney Banks and, by implication, the HR approach, Bonelle Strickling, a psychotherapist and Professor of Philosophy, is quoted in an article in the Vancouver Sun as objecting that “it makes it appear as if people can, through straightforward positive thinking, ‘choose’ to transcend their troubled upbringings and begin leading a contented life.” She goes on to say that “it can be depressing for people to hear it’s supposed to be that easy. It hasn’t been my experience that people can simply choose not to be negatively influenced by their past.” Referring to Banks’s own experience, she says, “Most people are not blessed with such a life-changing experience…. When most people change, it usually happens in a much more gradual way.” Strickling, however, displays by her very criticism, a lack in understanding of the Health Realization approach which has nothing at all to do with “choosing” or “positive thinking”.

The West Virginia Initiative for Innate Health (at West Virginia University Health Sciences Centre), which promotes HR/Innate Health and the philosophy of Sydney Banks through teaching, writing, and research, was the centre of controversy soon after its inception in 2000 as the Sydney Banks Institute for Innate Health. Initiated by Robert M. D’Alessandri, the Dean of the medical school there, the institute reportedly was criticized as pushing “junk science,” and Banks’s philosophy was characterized as “a kind of bastardized Buddhism” and “New Age.” William Post, an orthopaedic surgeon who quit the medical school because of the institute, was reported along with other unnamed professors to have accused the Sydney Banks Institute of promoting religion in a state-funded institution, and Harvey Silvergate, a civil-liberties lawyer, was quoted as agreeing that “essentially [the institute] seems like a cover for a religious-type belief system which has been prettified in order to be secular and even scientific.”

There is, however, no organised religion associated with the principles uncovered by Mr. Banks.

A Dr. Blaha, who resigned as chairman of Orthopaedics at WVU, was quoted as criticising the institute as being part of a culture at the Health Sciences Centre that, in his view, places too much emphasis on agreement, consensus, and getting along. Other professors reportedly supported the institute.

Anthony DiBartolomeo, chief of the rheumatology section, was quoted as calling it “a valuable addition” to the health-sciences centre, saying its greatest value was in helping students, residents, and patients deal with stress.

Reportedly in response to the controversy, the WVIIH changed its name from The Sydney Banks Institute to the West Virginia Initiative for Innate Health, although its mission remains unchanged.

Support for Specific Tenets of HR from other Philosophies and Approaches

Some of the tenets of HR are consistent with the theories of philosophers, authors and researchers independently developing other approaches to change and psychotherapy.

A large body of peer-reviewed case literature in psychotherapy by Milton Erickson, M.D., founding president of the American Society for Clinical Hypnosis, and others working in the field of Ericksonian psychotherapy, supports the notion that lasting change in psychotherapy can occur rapidly without directly addressing clients’ past problematic experiences.

Many case examples and a modest body of controlled outcome research in solution focused brief therapy (SFBT), have likewise supported the notion that change in psychotherapy can occur rapidly, without delving into the clients’ past negative experiences. Proponents of SFBT suggest that such change often occurs when the therapist assists clients to step out of their usual problem-oriented thinking.

The philosophy of social constructionism, which is echoed in SFBT, asserts that reality is reproduced by people acting on their interpretations and their knowledge of it. (HR asserts that thought creates one’s experience of the world.)

A major body of peer-reviewed research on “focusing”, a change process developed by philosopher Eugene Gendlin, supports the theory that progress in psychotherapy is dependent on something clients do inside themselves during pauses in the therapy process, and that a particular internal activity – “focusing” – can be taught to help clients improve their progress. The first step of the six-step process used to teach focusing involves setting aside one’s current worries and concerns to create a “cleared space” for effective inner reflection. Gendlin has called this first step by itself “a superior stress-reduction method”. (HR emphasizes the importance of quieting one’s insecure and negative thinking to reduce stress and gain access to “inner wisdom,” “common sense,” and well-being.)

Positive psychology emphasizes the human capacity for health and well-being, asserts the poor correlation between social circumstances and individual happiness, and insists on the importance of one’s thinking in determining one’s feelings.

Work by Herbert Benson argues that humans have an innate ‘breakout principle’ which provides creative solutions and peak experiences which allow the restoration of a ‘new-normal’ state of higher functioning. This breakout principle is activated by severing connections with current circular or repetitive thinking. This is heavily reminiscent of Health Realisation discussion of the Principle of Mind and of how it is activated.

Finally, resilience research, such as that by Emmy Werner, has demonstrated that many high-risk children display resilience and develop into normal, happy adults despite problematic developmental histories.

See also National Resilience Resource Centre LLC additional discussion of resilience research and complimentary science found on the Research page at http://www.nationalresilienceresource.com .

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Health_realization >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Distress Tolerance?


Distress tolerance is an emerging construct in psychology that has been conceptualised in several different ways. Broadly, it refers to an individual’s:

“perceived capacity to withstand negative emotional and/or other aversive states (e.g. physical discomfort), and the behavioral act of withstanding distressing internal states elicited by some type of stressor.”

Some definitions of distress tolerance have also specified that the endurance of these negative events occur in contexts in which methods to escape the distressor exist.


In the literature, differences in conceptualisations of distress tolerance have corresponded with two methods of assessing this construct.

As self-report inventories fundamentally assess an individual’s perception and reflection of constructs related to the self; self-report measures of distress tolerance (i.e. questionnaires) specifically focus on the perceived ability to endure distressful states, broadly defined. Some questionnaires focus specifically on emotional distress tolerance (e.g. the distress tolerance scale), some on distress tolerance of negative physical states (e.g. discomfort intolerance scale), and others focus specifically on tolerance of frustration as an overarching process of distress tolerance (e.g. frustration-discomfort scale).

In contrast, studies that incorporate behavioural or biobehavioural assessments of distress tolerance provide information about real behaviour rather than an individual’s perceptions. Examples of stress-inducing tasks include those that require the individual to persist in tracing a computerised mirror under timed conditions (i.e. computerised mirror tracing persistence task) or complete a series of time-sensitive math problems for which incorrect answers produce an aversive noise (i.e. computerised paced auditory serial addition task). Some behavioural tasks are conceptualised to assess physical distress tolerance, and require individuals to hold their breath for as long as possible (breath holding task).

As this is a nascent field of research, the relationships between perceptual and behavioural assessments of distress tolerance have not been clearly elucidated. Disentangling distinct components of emotional/psychological distress tolerance and physical distress tolerance within behavioural tasks also remains a challenge in the literature.

Theoretical Structures

Several models about the structural hierarchy of distress tolerance have been proposed. Some work suggests that physical and psychological tolerance are distinct constructs. Specifically, sensitivity to feelings of anxiety and tolerance of negative emotional states may be related to each other as aspects of a larger construct representing sensitivity and tolerance of affect broadly; discomfort surrounding physical stressors, however, was found to be an entirely separate construct not associated with sensitivity to emotional states. Notably, this preliminary work was conducted with self-report measures and findings are cross-sectional in nature. The authors advise that additional longitudinal work is necessary to corroborate these relationships and elucidate directions of causality.

Recent work expands on the distinctness of emotional and physical distress tolerance to a higher-order construct of global experiential distress tolerance. This framework draws upon tolerance constructs that have been historically studied as distinct from distress tolerance. The five following constructs are framed as lower-order factors for the global distress tolerance construct, and include:

  • Tolerance of uncertainty, or “the tendency to react emotionally, cognitively, or behaviourally to uncertain situations”.
  • Tolerance of ambiguity, or “the perceived tolerance of complicated, foreign, and/or vague situations of stimuli”.
  • Tolerance of frustration, or “the perceived capacity to withstand aggravation (e.g. thwarted life goals)”.
  • Tolerance of negative emotional states, or “the perceived capacity to withstand internal distress”.
  • Tolerance of physical sensations, or “the perceived capacity to withstand uncomfortable physical sensations”.

Within models that solely conceptualise distress tolerance as the ability to endure negative emotional states, distress tolerance is hypothesized to be multidimensional. This includes individual processes related to the anticipation of and experience with negative emotions, such as perceived and actual ability to tolerate the negative emotion, the appraisal of a given situation as acceptable or not, the degree to which an individual can regulate his/her emotion in the midst of a negative emotional experience, and amount of attention dedicated to processing the negative emotion.

Biological Bases

There are several candidate biological neural network mechanisms for distress tolerance. These proposed brain areas are based on the conceptualisation of distress tolerance as a function of reward learning. Within this framework, individuals learn to attune to and pursue reward; reduction of tension in escaping from a stressor is similarly framed as a reward and thus can be learned. Individuals differ in how quickly and for how long they display preferences for pursuing reward or in the case of distress tolerance, escaping from a distressful stimulus. Therefore, brain regions that are activated during reward processing and learning are hypothesized to also serve as neurobiological substrates for distress tolerance. For instance, activation intensity of dopamine neurons projecting to the nucleus accumbens, ventral striatum, and prefrontal cortex is associated with an individual’s predicted value of an immediate reward during a learning task. As the firing rate for these neurons increases, individuals predict high values of an immediate reward. During instances in which the predicted value is correct, the basal rate of neuronal firing remains the same. When the predicted reward value is below the actual value, neuronal firing rates increase when the reward is received, resulting in a learned response. When the expected reward value is below the actual value, the firing rate of these neurons decreases below baseline levels, resulting in a learned shift that reduces expectancies about reward value. It is posited that these same dopaminergic firing rates are associated with distress tolerance, in that learning the value of escaping a distressing stimulus is analogous to an estimation of an immediate reward There are several potential clinical implications if these posited distress tolerance substrates are corroborated. It may suggest that distress tolerance is malleable among individuals; interventions that change neuronal firing rates may shift predicted values of behaviours intended to escape a distressor and provide relief, thereby increasing distress tolerance.

Other neural areas may be implicated in moderating this reward learning process. Excitability of inhibitory medium spiny neurons in the nucleus accumbens and ventral striatum have been found to moderate the association between the value of an immediate reward and probability of pursuing reward or relief. Within rats, it has been demonstrated that increasing the excitability of these neurons via increased CREB expression resulted in an increased amount of time that the rats would keep their tail still when a noxious thermal paste was applied, as well as an increased amount of time spent in the open arms of a complex maze; these behaviours have been conceptualised as analogous distress tolerance in response to pain and anxiety.

Associations with Psychopathology

Distress tolerance is an emerging research topic in clinical psychology because it has been posited to contribute to the development and maintenance of several types of mental disorders, including mood and anxiety disorders such as major depressive disorder and generalised anxiety disorder, substance use and addiction, and personality disorders. In general, research on distress tolerance have found associations with these disorders that are tied closely to specific conceptualisations of distress tolerance. For instance, Borderline Personality Disorder is posited to be maintained through a chronic unwillingness to engage in or tolerate emotionally distressful states. Similarly, susceptibility to developing anxiety disorders is often characterised by low emotional distress tolerance. Low distress tolerance of both physical and emotional states is perceived to be a risk factor in maintaining and escalating addiction. Distress tolerance is particularly important in neurobiological theories that posit that advanced stages of addiction are driven by use of a substance to avoid physical and psychological withdrawal symptoms.

As a result of this interest in distress tolerance and its relationship with clinical psychopathology, several psychosocial treatments have been developed to improve distress tolerance among populations that are traditionally resistant to treatment. Many of these interventions (e.g. acceptance-based emotion regulation therapy) aims to boost distress tolerance by increasing the willingness to engage with emotion and meta-skills of acceptance of emotional conflict. Other behavioural interventions include components of building distress tolerance for various treatment targets, including acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT), functional analytic psychotherapy, integrative behavioural couples therapy, and mindfulness-based cognitive therapy. Multiple studies suggest that such distress tolerance interventions may be effective in treating generalised anxiety disorder, depression, and borderline personality disorder.

Therapy Approaches to Improving Distress Tolerance

ACT and DBT are therapy approaches which include specific focus on distress tolerance.

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An Overview of Psychological Resilience


Psychological resilience is the ability to cope mentally or emotionally with a crisis or to return to pre-crisis status quickly.

The term was coined in the 1970s by Emmy E. Werner, a psychologist, as she conducted a forty year long study of a cohort of Hawaiian children who came from low, socioeconomical back grounds. Resilience exists when the person uses “mental processes and behaviours in promoting personal assets and protecting self from the potential negative effects of stressors”. In simpler terms, psychological resilience exists in people who develop psychological and behavioural capabilities that allow them to remain calm during crises/chaos and to move on from the incident without long-term negative consequences. A lot of criticism of this topic comes from the fact that it is difficult to measure and test this psychological construct because resiliency can be interpreted in a variety of ways. Most psychological paradigms (biomedical, cognitive-behavioural, sociocultural, etc.) have their own perspective of what resilience looks like, where it comes from, and how it can be developed. Despite numerous definitions of psychological resilience, most of these definitions centre around two concepts:

  • Adversity; and
  • Positive adaptation.

Many psychologists agree that positive emotions, social support, and hardiness can influence an individual to become more resilient.

Refer to Scale of Protective Factors.

Brief History

The first research on resilience was published in 1973. The study used epidemiology, which is the study of disease prevalence, to uncover the risks and the protective factors that now help define resilience. A year later, the same group of researchers created tools to look at systems that support development of resilience.

Emmy Werner was one of the early scientists to use the term resilience in the 1970s. She studied a cohort of children from Kauai, Hawaii. Kauai was quite poor and many of the children in the study grew up with alcoholic or mentally ill parents. Many of the parents were also out of work. Werner noted that of the children who grew up in these detrimental situations, two-thirds exhibited destructive behaviours in their later teen years, such as chronic unemployment, substance abuse, and out-of-wedlock births (in case of teenage girls). However, one-third of these youngsters did not exhibit destructive behaviours. Werner called the latter group resilient. Thus, resilient children and their families were those who, by definition, demonstrated traits that allowed them to be more successful than non-resilient children and families.

Resilience also emerged as a major theoretical and research topic from the studies of children with mothers diagnosed with schizophrenia in the 1980s. In a 1989 study, the results showed that children with a schizophrenic parent may not obtain an appropriate level of comforting caregiving – compared to children with healthy parents – and that such situations often had a detrimental impact on children’s development. On the other hand, some children of ill parents thrived well and were competent in academic achievement, and therefore led researchers to make efforts to understand such responses to adversity.

Since the onset of the research on resilience, researchers have been devoted to discovering the protective factors that explain people’s adaptation to adverse conditions, such as maltreatment, catastrophic life events, or urban poverty. The focus of empirical work then has been shifted to understand the underlying protective processes. Researchers endeavour to uncover how some factors (e.g. connection to family) may contribute to positive outcomes.


Resilience is generally thought of as a “positive adaptation” after a stressful or adverse situation. When a person is “bombarded by daily stress, it disrupts their internal and external sense of balance, presenting challenges as well as opportunities.” However, the routine stressors of daily life can have positive impacts which promote resilience. It is still unknown what the correct level of stress is for each individual. Some people can handle greater amounts of stress than others. A portion of psychologists believe that it is not the stress itself that promotes resilience but rather the individual’s perception of their stress and their perceived personal level of control. The presence of stress allows people to practice this process. According to Germain and Gitterman (1996), stress is experienced in an individual’s life course at times of difficult life transitions, involving developmental and social change; traumatic life events, including grief and loss; and environmental pressures, encompassing poverty and community violence. Resilience is the integrated adaptation of physical, mental and spiritual aspects in a set of “good or bad” circumstances, a coherent sense of self that is able to maintain normative developmental tasks that occur at various stages of life. The Children’s Institute of the University of Rochester explains that “resilience research is focused on studying those who engage in life with hope and humour despite devastating losses”. It is important to note that resilience is not only about overcoming a deeply stressful situation, but also coming out of the said situation with “competent functioning”. Resiliency allows a person to rebound from adversity as a strengthened and more resourceful person. Some characteristics of psychological resilience include: an easy temperament, good self-esteem, planning skills, and a supportive environment inside and outside of the family. Aaron Antonovsky in 1979 stated that when an event is appraised as comprehensible (predictable), manageable (controllable), and somehow meaningful (explainable) a resilient response is more likely.


Psychological resilience is most commonly understood as a process. It is a tool a person can use and it is something that an individual develops overtime. Others assume it to be a trait of the individual, an idea more typically referred to as “resiliency”. Most research now shows that resilience is the result of individuals being able to interact with their environments and participate in processes that either promote well-being or protect them against the overwhelming influence of risk factors. This research could be used in support of psychological resilience being a process rather than a trait. Resilience is seen as something to develop. Making it something to pursue and not an endpoint.

Ray Williams (Canadian businessman and author) saw that resilience comes from people able to effectively cope with their environment. He believed that there are three basic ways individuals could react when faced with a difficult situation.

  • Respond with anger or aggression.
  • Become overwhelmed and shut down.
  • Feel the emotion about the situation and appropriately handle the emotion.

The third option is the one he believed that truly helps an individual promote wellness. Individuals that follow this pattern are people who show resilience. Their resilience comes from coping with the situation. People who follow the first and second option tend to label themselves as victims of their circumstance or they may blame others for their misfortune. They do not effectively cope with their environment, they become reactive, and they tend to cling to negative emotions. This often makes it difficult to focus on problem solving or bounce back. Those that are more resilient will respond to their conditions by coping, bouncing back, and looking for a solution. Along with continual coping methods, William believed that the resilience process can be aided by good environments. These environments include supportive social environments (such as families, communities, schools) and social policies.


Like other psychological phenomena, by defining specific psychological and affective states in certain ways, controversy over meaning will always ensue. How the term resilience is defined affects research focuses; different or insufficient definitions of resilience will lead to inconsistent research about the same concepts. Research on resilience has become more heterogeneous in its outcomes and measures, convincing some researchers to abandon the term altogether due to it being attributed to all outcomes of research where results were more positive than expected.

There is also some disagreement among researchers in the field as to whether psychological resilience is a character trait or state of being. Psychological resilience has also been referred to as ecological concept, ranging from micro to macro levels of interpretation. However, it is generally agreed upon that resilience is a buildable resource.

Recently there has also been evidence that resilience can indicate a capacity to resist a sharp decline in other harm even though a person temporarily appears to get worse. Similarly, studies have shown that adolescents who have a high level of adaptation (i.e. resilience) tend to struggle with dealing with other psychological problems later on in life. This is due to an overload of their stress response systems. There is evidence that the higher one’s resilience is, the lower their vulnerability.

Related Factors

Studies show that there are several factors which develop and sustain a person’s resilience:

  • The ability to make realistic plans and being capable of taking the steps necessary to follow through with them.
  • Confidence in one’s strengths and abilities.
  • Communication and problem-solving skills.
  • The ability to manage strong impulses and feelings.
  • Having good self-esteem.

However, these factors vary among different age groups. For example, these factors among older adults are external connections, grit, independence, self-care, self-acceptance, altruism, hardship experience, health status, and positive perspective on life.

Resilience is negatively correlated with personality traits of neuroticism and negative emotionality, which represents tendencies to see and react to the world as threatening, problematic, and distressing, and to view oneself as vulnerable. Positive correlations stands with personality traits of openness and positive emotionality, that represents tendencies to engage and confront the world with confidence in success and a fair value to self-directedness.

Positive Emotions

There is significant research found in scientific literature on the relationship between positive emotions and resilience. Studies show that maintaining positive emotions whilst facing adversity promote flexibility in thinking and problem solving. Positive emotions serve an important function in their ability to help an individual recover from stressful experiences and encounters. That being said, maintaining a positive emotionality aids in counteracting the physiological effects of negative emotions. It also facilitates adaptive coping, builds enduring social resources, and increases personal well-being.

The formation of conscious perception and the monitoring of one’s own socioemotional factors is considered a stabile aspect of positive emotions. This is not to say that positive emotions are merely a by-product of resilience, but rather that feeling positive emotions during stressful experiences may have adaptive benefits in the coping process of the individual. Empirical evidence for this prediction arises from research on resilient individuals who have a propensity for coping strategies that concretely elicit positive emotions, such as benefit-finding and cognitive reappraisal, humour, optimism, and goal-directed problem-focused coping. Individuals who tend to approach problems with these methods of coping may strengthen their resistance to stress by allocating more access to these positive emotional resources. Social support from caring adults encouraged resilience among participants by providing them with access to conventional activities.

Positive emotions not only have physical outcomes but also physiological ones. Some physiological outcomes caused by humour include improvements in immune system functioning and increases in levels of salivary immunoglobulin A, a vital system antibody, which serves as the body’s first line of defence in respiratory illnesses. Moreover, other health outcomes include faster injury recovery rate and lower readmission rates to hospitals for the elderly, and reductions in a patient’s stay in the hospital, among many other benefits. A study was done on positive emotions in trait-resilient individuals and the cardiovascular recovery rate following negative emotions felt by those individuals. The results of the study showed that trait-resilient individuals experiencing positive emotions had an acceleration in the speed in rebounding from cardiovascular activation initially generated by negative emotional arousal, i.e. heart rate and the like.

Forgiveness is also said to play a role in predicting resilience, among patients with chronic pain (but not the severity of the pain).

Social Support

Many studies show that the primary factor for the development of resilience is social support. While many competing definitions of social support exist, most can be thought of as the degree of access to, and use of, strong ties to other individuals who are similar to one’s self. Social support requires not only that you have relationships with others, but that these relationships involve the presence of solidarity and trust, intimate communication, and mutual obligation both within and outside the family.

In military studies it has been found that resilience is also dependent on group support: unit cohesion and morale is the best predictor of combat resiliency within a unit or organisation. Resilience is highly correlated to peer support and group cohesion. Units with high cohesion tend to experience a lower rate of psychological breakdowns than units with low cohesion and morale. High cohesion and morale enhance adaptive stress reactions. Post-war veterans who had more social support were less likely to develop post-traumatic stress disorder.

Other Factors

A study was conducted among high-achieving professionals who seek challenging situations that require resilience. Research has examined 13 high achievers from various professions, all of whom had experienced challenges in the workplace and negative life events over the course of their careers but who had also been recognised for their great achievements in their respective fields. Participants were interviewed about everyday life in the workplace as well as their experiences with resilience and thriving. The study found six main predictors of resilience: positive and proactive personality, experience and learning, sense of control, flexibility and adaptability, balance and perspective, and perceived social support. High achievers were also found to engage in many activities unrelated to their work such as engaging in hobbies, exercising, and organizing meetups with friends and loved ones.

Additional factors are also associated with resilience, like the capacity to make realistic plans, having self-confidence and a positive self image, developing communications skills, and the capacity to manage strong feelings and impulses.

Temperamental and constitutional disposition is considered as a major factor in resilience. It is one of the necessary precursors of resilience along with warmth in family cohesion and accessibility of prosocial support systems. There are three kinds of temperamental systems that play part in resilience, they are the appetitive system, defensive system and attentional system.

Another protective factor is related to moderating the negative effects of environmental hazards or a stressful situation in order to direct vulnerable individuals to optimistic paths, such as external social support. More specifically a 1995 study distinguished three contexts for protective factors:

  • Personal attributes, including outgoing, bright, and positive self-concepts;
  • The family, such as having close bonds with at least one family member or an emotionally stable parent; and
  • The community, such as receiving support or counsel from peers.

Furthermore, a study of the elderly in Zurich, Switzerland, illuminated the role humour plays as a coping mechanism to maintain a state of happiness in the face of age-related adversity.

Besides the above distinction on resilience, research has also been devoted to discovering the individual differences in resilience. Self-esteem, ego-control, and ego-resiliency are related to behavioural adaptation. For example, maltreated children who feel good about themselves may process risk situations differently by attributing different reasons to the environments they experience and, thereby, avoid producing negative internalised self-perceptions. Ego-control is “the threshold or operating characteristics of an individual with regard to the expression or containment” of their impulses, feelings, and desires. Ego-resilience refers to “dynamic capacity, to modify his or her model level of ego-control, in either direction, as a function of the demand characteristics of the environmental context”.

Maltreated children who experienced some risk factors (e.g. single parenting, limited maternal education, or family unemployment), showed lower ego-resilience and intelligence than non-maltreated children. Furthermore, maltreated children are more likely than non-maltreated children to demonstrate disruptive-aggressive, withdraw, and internalised behaviour problems. Finally, ego-resiliency, and positive self-esteem were predictors of competent adaptation in the maltreated children.

Demographic information (e.g. gender) and resources (e.g. social support) are also used to predict resilience. Examining people’s adaptation after disaster showed women were associated with less likelihood of resilience than men. Also, individuals who were less involved in affinity groups and organisations showed less resilience.

Certain aspects of religions, spirituality, or mindfulness may, hypothetically, promote or hinder certain psychological virtues that increase resilience. Research has not established connection between spirituality and resilience. According to the 4th edition of Psychology of Religion by Hood, et al., the “study of positive psychology is a relatively new development…there has not yet been much direct empirical research looking specifically at the association of religion and ordinary strengths and virtues”. In a review of the literature on the relationship between religiosity/spirituality and PTSD, amongst the significant findings, about half of the studies showed a positive relationship and half showed a negative relationship between measures of religiosity/spirituality and resilience. The United States Army has received criticism for promoting spirituality in its (then) new Comprehensive Soldier Fitness programme as a way to prevent PTSD, due to the lack of conclusive supporting data.

Biological Models

Three notable bases for resilience – self-confidence, self-esteem and self-concept – all have roots in three different nervous systems – respectively, the somatic nervous system, the autonomic nervous system and the central nervous system.

Research indicates that like trauma, resilience is influenced by epigenetic modifications. Increased DNA methylation of the growth factor Gdfn in certain brain regions promotes stress resilience, as does molecular adaptations of the blood brain barrier.

The two primary neurotransmitters responsible for stress buffering within the brain are dopamine and endogenous opioids as evidenced by current research showing that dopamine and opioid antagonists increased stress response in both humans and animals. Primary and secondary rewards reduce negative reactivity of stress in the brain in both humans and animals. The relationship between social support and stress resilience is thought to be mediated by the oxytocin system’s impact on the hypothalamic-pituitary-adrenal axis.

“Resilience, conceptualized as a positive bio-psychological adaptation, has proven to be a useful theoretical context for understanding variables for predicting long-term health and well-being”.

Building Resilience

In cognitive behavioural therapy (CBT), building resilience is a matter of mindfully changing basic behaviours and thought patterns. The first step is to change the nature of self-talk. Self-talk is the internal monologue people have that reinforce beliefs about the person’s self-efficacy and self-value. To build resilience, the person needs to eliminate negative self-talk, such as “I can’t do this” and “I can’t handle this”, and to replace it with positive self-talk, such as “I can do this” and “I can handle this”. This small change in thought patterns helps to reduce psychological stress when a person is faced with a difficult challenge. The second step a person can take to build resilience is to be prepared for challenges, crises, and emergencies. In business, preparedness is created by creating emergency response plans, business continuity plans, and contingency plans. For personal preparedness, the individual can create a financial cushion to help with economic crises, he/she can develop social networks to help him/her through trying personal crises, and he/she can develop emergency response plans for his/her household.

Resilience is also enhanced by developing effective coping skills for stress. Coping skills help the individual to reduce stress levels, so they remain functional. Coping skills include using meditation, exercise, socialisation, and self-care practices to maintain a healthy level of stress, but there are many other lists associated with psychological resilience.

The American Psychological Association suggests “10 Ways to Build Resilience”, which are to:

  • Maintain good relationships with close family members, friends and others;
  • Avoid seeing crises or stressful events as unbearable problems;
  • Accept circumstances that cannot be changed;
  • Develop realistic goals and move towards them;
  • Take decisive actions in adverse situations;
  • Look for opportunities for self-discovery after a struggle with loss;
  • Develop self-confidence;
  • Keep a long-term perspective and consider the stressful event in a broader context;
  • Maintain a hopeful outlook, expecting good things and visualizing what is wished; and
  • Take care of one’s mind and body, exercising regularly, paying attention to one’s own needs and feelings.

The Besht model of natural resilience building in an ideal family with positive access and support from family and friends, through parenting illustrates four key markers. They are:

  • Realistic upbringing.
  • Effective risk communications.
  • Positivity and restructuring of demanding situations.
  • Building self efficacy and hardiness.

In this model, self-efficacy is the belief in one’s ability to organise and execute the courses of action required to achieve necessary and desired goals and hardiness is a composite of interrelated attitudes of commitment, control, and challenge.

A number of self-help approaches to resilience-building have been developed, drawing mainly on the theory and practice of CBT and rational emotive behaviour therapy (REBT). For example, a group cognitive-behavioural intervention, called the Penn Resiliency Programme (PRP), has been shown to foster various aspects of resilience. A meta-analysis of 17 PRP studies showed that the intervention significantly reduces depressive symptoms over time.

The idea of ‘resilience building’ is debatably at odds with the concept of resilience as a process, since it is used to imply that it is a developable characteristic of oneself. Those who view resilience as a description of doing well despite adversity, view efforts of ‘resilience building’ as method to encourage resilience. Bibliotherapy, positive tracking of events, and enhancing psychosocial protective factors with positive psychological resources are other methods for resilience building. In this way, increasing an individual’s resources to cope with or otherwise address the negative aspects of risk or adversity is promoted, or builds, resilience.

Contrasting research finds that strategies to regulate and control emotions, in order to enhance resilience, allows for better outcomes in the event of mental illness. While initial studies of resilience originated with developmental scientists studying children in high-risk environments, a study on 230 adults diagnosed with depression and anxiety that emphasized emotional regulation, showed that it contributed to resilience in patients. These strategies focused on planning, positively reappraising events, and reducing rumination helped in maintaining a healthy continuity. Patients with improved resilience were found to yield better treatment outcomes than patients with non-resilience focused treatment plans, providing potential information for supporting evidence based psychotherapeutic interventions that may better handle mental disorders by focusing on the aspect of psychological resilience.

Building Resilience Through Language

As the world globalises, language learning and communication have proven to be helpful factors in developing resilience in people who travel, study abroad, work internationally, or in those who find themselves as refugees in countries where their home language is not spoken.

Research conducted by the British Council ties a strong relationship between language and resilience in refugees. Their language for resilience research conducted in partnership with institutions and communities from the Middle East, Africa, Europe and the Americas claims that providing adequate English-learning programmes and support for Syrian refugees builds resilience not only in the individual, but also in the host community. Their findings reported five main ways through which language builds resilience: home language and literacy development; access to education, training, and employment; learning together and social cohesion; addressing the effects of trauma on learning; and building inclusivity.

The language for resilience research suggests that further development of home language and literacy helps create the foundation for a shared identity. By maintaining the home language, even when displaced, a person not only learns better in school, but enhances the ability to learn other languages. This enhances resilience by providing a shared culture and sense of identity that allows refugees to maintain close relationships to others who share their identity and sets them up to possibly return one day. Thus, identity is not stripped and a sense of belonging persists.

Access to education, training, and employment opportunities allow refugees to establish themselves in their host country and provides more ease when attempting to access information, apply to work or school, or obtain professional documentation. Securing access to education or employment is largely dependent on language competency, and both education and employment provide security and success that enhance resilience and confidence.

Learning together encourages resilience through social cohesion and networks. When refugees engage in language-learning activities with host communities, engagement and communication increases. Both refugee and host community are more likely to celebrate diversity, share their stories, build relationships, engage in the community, and provide each other with support. This creates a sense of belonging with the host communities alongside the sense of belonging established with other members of the refugee community through home language.

Additionally, language programmes and language learning can help address the effects of trauma by providing a means to discuss and understand. Refugees are more capable of expressing their trauma, including the effects of loss, when they can effectively communicate with their host community. Especially in schools, language learning establishes safe spaces through storytelling, which further reinforces comfort with a new language, and can in turn lead to increased resilience.

The fifth way, building inclusivity, is more focused on providing resources. By providing institutions or schools with more language-based learning and cultural material, the host community can better learn how to best address the needs of the refugee community. This overall addressing of needs feeds back into the increased resilience of refugees by creating a sense of belonging and community.

Additionally, a study completed by Kate Nguyen, Nile Stanley, Laurel Stanley, and Yonghui Wang shows the impacts of storytelling in building resilience. This aligns with many of the five factors identified by the study completed by the British Council, as it emphasizes the importance of sharing traumatic experiences through language. This study in particular showed that those who were exposed to more stories, from family or friends, had a more holistic view of life’s struggles, and were thus more resilient, especially when surrounded by foreign languages or attempting to learn a new language.

Other Development Programmes

The Head Start programme was shown to promote resilience. So was the Big Brothers Big Sisters Programme, Centred Coaching & Consulting, the Abecedarian Early Intervention Project, and social programmes for youth with emotional or behavioural difficulties.

The Positive Behaviour Supports and Intervention programme is a successful trauma-informed, resilience-based for elementary age students with four components. These four elements include positive reinforcements such as encouraging feedback, understanding that behaviour is a response to unmet needs or a survival response, promoting belonging, mastery and independence, and finally, creating an environment to support the student through sensory tools, mental health breaks and play.

Tuesday’s Children, a family service organisation that made a long-term commitment to the individuals that have lost loved ones to 9/11 and terrorism around the world, works to build psychological resilience through programmes such as Mentoring and Project COMMON BOND, an 8-day peace-building and leadership initiative for teens, ages 15-20, from around the world who have been directly impacted by terrorism.

Military organisations test personnel for the ability to function under stressful circumstances by deliberately subjecting them to stress during training. Those students who do not exhibit the necessary resilience can be screened out of the training. Those who remain can be given stress inoculation training. The process is repeated as personnel apply for increasingly demanding positions, such as special forces.


Resilience in children refers to individuals who are doing better than expected, given a history that includes risk or adverse experience. Once again, it is not a trait or something that some children simply possess. There is no such thing as an ‘invulnerable child’ that can overcome any obstacle or adversity that he or she encounters in life – and in fact, the trait is quite common. All children share the uniqueness of an upbringing, experiences which could be positive or negative. Adverse Childhood Experiences (ACE’s) are events which occur in a child’s life that could lead to maladaptive symptoms such as feeling tension, low mood, repetitive and recurring thoughts, and avoidance. The psychological resilience to overcome adverse events is not the sole explanation of why some children experience post-traumatic growth and some do not. Resilience is the product of a number of developmental processes over time, that has allowed children experience small exposures to adversity or some sort of age appropriate challenges to develop mastery and continue to develop competently. This gives children a sense of personal pride and self-worth.

Research on ‘protective factors’, which are characteristics of children or situations that particularly help children in the context of risk has helped developmental scientists to understand what matters most for resilient children. Two of these that have emerged repeatedly in studies of resilient children are good cognitive functioning (like cognitive self-regulation and IQ) and positive relationships (especially with competent adults, like parents). Children who have protective factors in their lives tend to do better in some risky contexts when compared to children without protective factors in the same contexts. However, this is not a justification to expose any child to risk. Children do better when not exposed to high levels of risk or adversity.

Building in the Classroom

Resilient children within classroom environments have been described as working and playing well and holding high expectations, have often been characterised using constructs such as locus of control, self-esteem, self-efficacy, and autonomy. All of these things work together to prevent the debilitating behaviours that are associated with learned helplessness.

Role of the Community

Communities play a huge role in fostering resilience. The clearest sign of a cohesive and supportive community is the presence of social organisations that provide healthy human development. Services are unlikely to be used unless there is good communication concerning them. Children who are repeatedly relocated do not benefit from these resources, as their opportunities for resilience-building, meaningful community participation are removed with every relocation

Role of the Family

Fostering resilience in children is favoured in family environments that are caring and stable, hold high expectations for children’s behaviour and encourage participation in the life of the family. Most resilient children have a strong relationship with at least one adult, not always a parent, and this relationship helps to diminish risk associated with family discord. The definition of parental resilience, as the capacity of parents to deliver a competent and quality level of parenting to children, despite the presence of risk factors, has proven to be a very important role in children’s resilience. Understanding the characteristics of quality parenting is critical to the idea of parental resilience. Even if divorce produces stress, the availability of social support from family and community can reduce this stress and yield positive outcomes. Any family that emphasizes the value of assigned chores, caring for brothers or sisters, and the contribution of part-time work in supporting the family helps to foster resilience. Resilience research has traditionally focused on the well-being of children, with limited academic attention paid to factors that may contribute to the resilience of parents.

Families in Poverty

Numerous studies have shown that some practices that poor parents utilise help promote resilience within families. These include frequent displays of warmth, affection, emotional support; reasonable expectations for children combined with straightforward, not overly harsh discipline; family routines and celebrations; and the maintenance of common values regarding money and leisure. According to sociologist Christopher B. Doob, “Poor children growing up in resilient families have received significant support for doing well as they enter the social world—starting in daycare programs and then in schooling.”


Beyond preventing bullying, it is also important to consider how interventions based on emotional intelligence are important in the case that bullying does occur. Increasing emotional intelligence may be an important step in trying to foster resilience among victims. When a person faces stress and adversity, especially of a repetitive nature, their ability to adapt is an important factor in whether they have a more positive or negative outcome.

A 2013 study examined adolescents who illustrated resilience to bullying and found some interesting gendered differences, with higher behavioural resilience found among girls and higher emotional resilience found among boys. Despite these differences, they still implicated internal resources and negative emotionality in either encouraging or being negatively associated with resilience to bullying respectively and urged for the targeting of psychosocial skills as a form of intervention. Emotional intelligence has been illustrated to promote resilience to stress and as mentioned previously, the ability to manage stress and other negative emotions can be preventative of a victim going on to perpetuate aggression. One factor that is important in resilience is the regulation of one’s own emotions. Schneider et al. (2013) found that emotional perception was significant in facilitating lower negative emotionality during stress and Emotional Understanding facilitated resilience and has a positive correlation with positive affect.


Many years and sources of research indicate that there are a few consistent protective factors of young children despite differences in culture and stressors (poverty, war, divorce of parents, natural disasters, etc.):

  • Capable parenting.
  • Other close relationships.
  • Intelligence.
  • Self-control.
  • Motivation to succeed.
  • Self-confidence & self-efficacy.
  • Faith, hope, belief life has meaning.
  • Effective schools.
  • Effective communities.
  • Effective cultural practices.

Ann Masten coins these protective factors as “ordinary magic,” the ordinary human adaptive systems that are shaped by biological and cultural evolution. In her book, Ordinary Magic: Resilience in Development, she discusses the “immigrant paradox”, the phenomenon that first-generation immigrant youth are more resilient than their children. Researchers hypothesize that “there may be culturally based resiliency that is lost with succeeding generations as they become distanced from their culture of origin.” Another hypothesis is that those who choose to immigrate are more likely to be more resilient.

Research by Rosemary Gonzalez and Amado M. Padilla on the academic resilience of Mexican-American high school students reveal that while a sense of belonging to school is the only significant predictor of academic resilience, a sense of belonging to family, a peer group, and a culture can also indicate higher academic resilience. “Although cultural loyalty overall was not a significant predictor of resilience, certain cultural influences nonetheless contribute to resilient outcomes, like familism and cultural pride and awareness.” The results of Gonzalez and Padilla’s study “indicate a negative relationship between cultural pride and the ethnic homogeneity of a school.” They hypothesize that “ethnicity becomes a salient and important characteristic in more ethnically diverse settings”.

Considering the implications of the research by Masten, Gonzalez, and Padilla, a strong connection with one’s cultural identity is an important protective factor against stress and is indicative of increased resilience. While many additional classroom resources have been created to promote resilience in developing students, the most effective ways to ensure resilience in children is by protecting their natural adaptive systems from breaking down or being hijacked. At home, resilience can be promoted through a positive home environment and emphasized cultural practices and values. In school, this can be done by ensuring that each student develops and maintains a sense of belonging to the school through positive relationships with classroom peers and a caring teacher. Research on resilience consistently shows that a sense of belonging – whether it be in a culture, family, or another group – greatly predicts resiliency against any given stressor.

Specific Situations


Often divorce is viewed as detrimental to one’s emotional health, but studies have shown that cultivating resilience may be beneficial to all parties involved. The level of resilience a child will experience after their parents have split is dependent on both internal and external variables. Some of these variables include their psychological and physical state and the level of support they receive from their schools, friends, and family friends. The ability to deal with these situations also stems from the child’s age, gender, and temperament. Children will experience divorce differently and thus their ability to cope with divorce will differ too. About 20-25% of children will “demonstrate severe emotional and behavioural problems” when going through a divorce. This percentage is notably higher than the 10% of children exhibiting similar problems in married families. Despite this, approximately 75-80% of these children will “develop into well-adjusted adults with no lasting psychological or behavioural problems”. This comes to show that most children have the tools necessary to allow them to exhibit the resilience needed to overcome their parents’ divorce.

The effects of the divorce extend past the separation of both parents. The remaining conflict between parents, financial problems, and the re-partnering or remarriage of parents can cause lasting stress. Studies conducted by Booth and Amato (2001) have shown that there is no correlation between post-divorce conflict and the child’s ability to adjust to their life circumstance. On the other hand, Hetherington (1999) completed research on this same topic and did find adverse effects in children. In regards to the financial standing of a family, divorce does have the potential to reduce the children’s style of living. Child support is often given to help cover basic needs such as schooling. If the parents’ finances are already scarce then their children may not be able to participate in extracurricular activities such as sports and music lessons, which can be detrimental to their social lives.

Re-partnering or remarrying can bring in additional levels of conflict and anger into their home environment. One of the reasons that re-partnering causes additional stress is because of the lack of clarity in roles and relationships; the child may not know how to react and behave with this new “parent” figure in their life. In most cases, bringing in a new partner/spouse will be the most stressful when done shortly after the divorce. In the past, divorce had been viewed as a “single event”, but now research shows that divorce encompasses multiple changes and challenges. It is not only internal factors that allow for resiliency, but the external factors in the environment are critical for responding to the situation and adapting. Certain programmes such as the 14-week Children’s Support Group and the Children of Divorce Intervention Programme may help a child cope with the changes that occur from a divorce.

Natural Disasters

Resilience after a natural disaster can be gauged in a number of different ways. It can be gauged on an individual level, a community level, and on a physical level. The first level, the individual level, can be defined as each independent person in the community. The second level, the community level, can be defined as all those inhabiting the locality affected. Lastly, the physical level can be defined as the infrastructure of the locality affected.

UNESCAP funded research on how communities show resiliency in the wake of natural disasters. They found that, physically, communities were more resilient if they banded together and made resiliency an effort of the whole community. Social support is key in resilient behaviour, and especially the ability to pool resources. In pooling social, natural, and economic resources, they found that communities were more resilient and able to over come disasters much faster than communities with an individualistic mindset.

The World Economic Forum met in 2014 to discuss resiliency after natural disasters. They conclude that countries that are more economically sound, and have more individuals with the ability to diversify their livelihoods, will show higher levels of resiliency. This has not been studied in depth yet, but the ideas brought about through this forum appear to be fairly consistent with already existing research.

Research indicates that resilience following natural disasters can be predicted by the level of emotion an individual experienced and were able to process within and following the disaster. Those who employ emotional styles of coping were able to grow from their experiences and then help others. In these instances, experiencing emotions was adaptive. Those who did not engage with their emotions and employed avoidant and suppressive coping styles had poorer mental health outcomes following disaster.

Death of a Family Member

Little research has been done on the topic of family resilience in the wake of the death of a family member. Traditionally, clinical attention to bereavement has focused on the individual mourning process rather than on those of the family unit as a whole. Resiliency is distinguished from recovery as the “ability to maintain a stable equilibrium” which is conducive to balance, harmony, and recovery. Families must learn to manage familial distortions caused by the death of the family member, which can be done by reorganizing relationships and changing patterns of functioning to adapt to their new situation. Exhibiting resilience in the wake of trauma can successfully traverse the bereavement process without long-term negative consequences.

One of the healthiest behaviours displayed by resilient families in the wake of a death is honest and open communication. This facilitates an understanding of the crisis. Sharing the experience of the death can promote immediate and long-term adaptation to the recent loss of a loved one. Empathy is a crucial component in resilience because it allows mourners to understand other positions, tolerate conflict, and be ready to grapple with differences that may arise. Another crucial component to resilience is the maintenance of a routine that helps to bind the family together through regular contact and order. The continuation of education and a connection with peers and teachers at school is an important support for children struggling with the death of a family member.

Professional Settings

Resilience has also been examined in the context of failure and setbacks in workplace settings. Representing one of the core constructs of positive organizational behaviour (Luthans, 2002), and given increasingly disruptive and demanding work environments, scholars’ and practitioners’ attention to psychological resilience in organisations has greatly increased. This research has highlighted certain personality traits, personal resources (e.g. self-efficacy, work-life balance, social competencies), personal attitudes (e.g., sense of purpose, job commitment), positive emotions, and work resources (e.g. social support, positive organisational context) as potential facilitators of workplace resilience.

Beyond studies on general workplace resilience, attention has been directed to the role of resilience in innovative contexts. Due to high degrees of uncertainty and complexity in the innovation process, failure and setbacks are naturally happening frequently in this context. As such failure and setbacks can have strong and harmful effects on affected individuals’ motivation and willingness to take risks, their resilience is essential to productively engage in future innovative activities. To account for the peculiarities of the innovation context, a resilience construct specifically aligned to this unique context was needed to address the need to diagnose and develop innovators’ resilience to minimise the human cost of failure and setbacks in innovation. As a context-specific conceptualisation of resilience, Innovator Resilience Potential (IRP) serves this purpose and captures the potential for innovative functioning after the experience of failure or setbacks in the innovation process and for handling future setbacks. Based on Bandura’s social cognitive theory, IRP is proposed to consist of six components: self-efficacy, outcome expectancy, optimism, hope, self-esteem, and risk propensity. The concept of IRP thus reflects a process perspective on resilience. On the one hand, in this process, IRP can be seen as an antecedent of how a setback affects an innovator. On the other hand, IRP can be seen as an outcome of the process that, in turn, is influenced by the setback situation. Recently, a measurement scale of IRP was developed and validated.

Cross-Cultural Resilience

Areas of Difference

There is controversy about the indicators of good psychological and social development when resilience is studied across different cultures and contexts. The American Psychological Association’s Task Force on Resilience and Strength in Black Children and Adolescents, for example, notes that there may be special skills that these young people and families have that help them cope, including the ability to resist racial prejudice. Researchers of indigenous health have shown the impact of culture, history, community values, and geographical settings on resilience in indigenous communities. People who cope may also show “hidden resilience” when they do not conform with society’s expectations for how someone is supposed to behave (in some contexts, aggression may be required to cope, or less emotional engagement may be protective in situations of abuse).

Resilience in Individualist and Collectivist Communities

Individualist cultures, such as those of the US, Austria, Spain, and Canada, emphasize personal goals, initiatives, and achievements. Independence, self-reliance, and individual rights are highly valued by members of individualistic cultures. Economic, political, and social policies reflect the culture’s interest in individualism. The ideal person in individualist societies is assertive, strong, and innovative. People in this culture tend to describe themselves in terms of their unique traits- “I am analytical and curious” (Ma et al. 2004). Comparatively, in places like Japan, Sweden, Turkey, and Guatemala, Collectivist cultures emphasize family and group work goals. The rules of these societies promote unity, brotherhood, and selflessness. Families and communities practice cohesion and cooperation. The ideal person in collectivist societies is trustworthy, honest, sensitive, and generous- emphasizing intrapersonal skills. Collectivists tend to describe themselves in terms of their roles – “I am a good husband and a loyal friend” (Ma et al. 2004). In a study on the consequences of disaster on a culture’s individualism, researchers operationalised these cultures by identifying indicative phrases in a society’s literature. Words that showed the theme of individualism include, “able, achieve, differ, own, personal, prefer, and special.” Words that indicated collectivism include, “belong, duty, give, harmony, obey, share, together.”

Differences in Response to Natural Disasters

Natural disasters threaten to destroy communities, displace families, degrade cultural integrity, and diminish an individual’s level of functioning. Comparing individualist community reactions to collectivist community responses after natural disasters illustrates their differences and respective strengths as tools of resilience. Some suggest that disasters reduce individual agency and sense of autonomy as it strengthens the need to rely on other people and social structures. Therefore, countries/regions with heightened exposure to disaster should cultivate collectivism. However, Withey (1962) and Wachtel (1968) conducted interviews and experiments on disaster survivors which indicated that disaster-induced anxiety and stress decrease one’s focus on social-contextual information – a key component of collectivism. In this way, disasters may lead to increased individualism.

Mauch and Pfister (2004) questioned the association between socio-ecological indicators and cultural-level change in individualism. In their research, for each socio-ecological indicator, frequency of disasters was associated with greater (rather than less) individualism. Supplementary analyses indicated that the frequency of disasters was more strongly correlated with individualism-related shifts than was the magnitude of disasters or the frequency of disasters qualified by the number of deaths. Baby-naming practices is one interesting indicator of change. According to Mauch and Pfister (2004), urbanization was linked to preference for uniqueness in baby-naming practices at a 1-year lag, secularism was linked to individualist shifts in interpersonal structure at both lags, and disaster prevalence was linked to more unique naming practices at both lags. Secularism and disaster prevalence contributed mainly to shifts in naming practices.

There is a gap in disaster recovery research that focuses on psychology and social systems but does not adequately address interpersonal networking or relationship formation and maintenance. A disaster response theory holds that individuals who use existing communication networks fare better during and after disasters. Moreover, they can play important roles in disaster recovery by taking initiative to organize and help others recognise and use existing communication networks and coordinate with institutions which correspondingly should strengthen relationships with individuals during normal times so that feelings of trust exist during stressful ones.

In a collectivist sense, building strong, self-reliant communities, whose members know each other, know each other’s needs and are aware of existing communication networks, looks like an optimum defence against disasters.

In comparing these cultures, there is really no way to measure resilience, but one can look at the collateral consequences of a disaster to a country to gauge its resilience.

  • Collectivist resilience:
    • Returning to routine.
    • Rebuilding family structures.
    • Communal sharing of resources.
    • Emotional expression of grief and loss to a supportive listener.
    • Finding benefits from the disaster experience.
  • Individualist resilience:
    • Redistribution of power/resources.
    • Returning to routine.
    • Emotional expression through formal support systems.
    • Confrontation of the problem.
    • Reshaping one’s outlook after the disaster experience.

Whereas individualistic societies promote individual responsibility for self-sufficiency, the collectivistic culture defines self-sufficiency within an interdependent communal context (Kayser et al. 2008). Even where individualism is salient, a group thrives when its members choose social over personal goals and seek to maintain harmony and where they value collectivist over individualist behaviour (McAuliffe et al. 2003).

The Concept of Resilience in Language

While not all languages have a direct translation for the English word “resilience”, nearly every culture and community globally has a word which relates to a similar concept. The differences between the literal meanings of translated words shows that there is a common understanding of what resilience is. Even if a word does not directly translate to “resilience” in English, it relays a meaning similar enough to the concept and is used as such within the language.

If a specific word for resilience does not exist in a language, speakers of that language typically assign a similar word that insinuates resilience based on context. Many languages use words that translate to “elasticity” or “bounce”, which are used in context to capture the meaning of resilience. For example, one of the main words for “resilience” in Chinese literally translates to “rebound”, one of the main words for “resilience” in Greek translates to “bounce”, and one of the main words for “resilience” in Russian translates to “elasticity,” just as it does in German. However, this is not the case for all languages. For example, if a Spanish speaker wanted to say “resilience”, their main two options translate to “resistance” and “defence against adversity”. Many languages have words that translate better to “tenacity” or “grit” better than they do to “resilience”. While these languages may not have a word that exactly translates to “resilience”, note that English speakers often use tenacity or grit when referring to resilience. While one of the Greek words for “resilience” translates to “bounce”, another option translates to “cheerfulness”. Moreover, Arabic has a word solely for resilience, but also two other common expressions to relay the concept, which directly translate to “capacity on deflation” or “reactivity of the body”, but are better translated as “impact strength” and “resilience of the body” respectively. On the other hand, a few languages, such as Finnish, have created words to express resilience in a way that cannot be translated back to English. In Finnish, the word “sisu” could most closely be translated to mean “grit” in English, but blends the concepts of resilience, tenacity, determination, perseverance, and courage into one word that has even become a facet of Finnish culture and earned its place as a name for a few Finnish brands.

Criticism of Application

Brad Evans and Julian Reid criticise resilience discourse and its rising popularity in their book, Resilient Life. The authors assert that policies of resilience can put the onus of disaster response on individuals rather than publicly coordinated efforts. Tied to the emergence of neoliberalism, climate change, third-world development, and other discourses, Evans and Reid argue that promoting resilience draws attention away from governmental responsibility and towards self-responsibility and healthy psychological effects such as post-traumatic growth.

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What is the Health Belief Model?


The health belief model (HBM) is a social psychological health behaviour change model developed to explain and predict health-related behaviours, particularly in regard to the uptake of health services.

The HBM was developed in the 1950s by social psychologists at the US Public Health Service and remains one of the best known and most widely used theories in health behaviour research. The HBM suggests that people’s beliefs about health problems, perceived benefits of action and barriers to action, and self-efficacy explain engagement (or lack of engagement) in health-promoting behaviour. A stimulus, or cue to action, must also be present in order to trigger the health-promoting behaviour.

Original Health Belief Model.

Brief History

One of the first theories of health behaviour, the HBM was developed in 1950s by social psychologists Irwin M. Rosenstock, Godfrey M. Hochbaum, S. Stephen Kegeles, and Howard Leventhal at the US Public Health Service. At that time, researchers and health practitioners were worried because few people were getting screened for tuberculosis (TB), even if mobile X-ray cars went to neighbourhoods. The HBM has been applied to predict a wide variety of health-related behaviours such as being screened for the early detection of asymptomatic diseases and receiving immunisations. More recently, the model has been applied to understand intentions to vaccinate (e.g. COVID-19), responses to symptoms of disease, compliance with medical regimens, lifestyle behaviours (e.g. sexual risk behaviours), and behaviours related to chronic illnesses, which may require long-term behaviour maintenance in addition to initial behaviour change. Amendments to the model were made as late as 1988 to incorporate emerging evidence within the field of psychology about the role of self-efficacy in decision-making and behaviour.

Health Belief Model in action.

Theoretical Constructs

The HBM theoretical constructs originate from theories in Cognitive Psychology. In the early twentieth century, cognitive theorists believed that reinforcements operated by affecting expectations rather than by affecting behaviour directly. Mental processes are severe consists of cognitive theories that are seen as expectancy-value models, because they propose that behaviour is a function of the degree to which people value a result and their evaluation of the expectation, that a certain action will lead that result. In terms of the health-related behaviours, the value is avoiding sickness. The expectation is that a certain health action could prevent the condition for which people consider they might be at risk.

The following constructs of the HBM are proposed to vary between individuals and predict engagement in health-related behaviours.

Perceived Susceptibility

Perceived susceptibility refers to subjective assessment of risk of developing a health problem. The HBM predicts that individuals who perceive that they are susceptible to a particular health problem will engage in behaviours to reduce their risk of developing the health problem. Individuals with low perceived susceptibility may deny that they are at risk for contracting a particular illness. Others may acknowledge the possibility that they could develop the illness, but believe it is unlikely. Individuals who believe they are at low risk of developing an illness are more likely to engage in unhealthy, or risky, behaviours. Individuals who perceive a high risk that they will be personally affected by a particular health problem are more likely to engage in behaviours to decrease their risk of developing the condition.

The combination of perceived severity and perceived susceptibility is referred to as perceived threat. Perceived severity and perceived susceptibility to a given health condition depend on knowledge about the condition. The HBM predicts that higher perceived threat leads to a higher likelihood of engagement in health-promoting behaviours.

Perceived Severity

Perceived severity refers to the subjective assessment of the severity of a health problem and its potential consequences. The HBM proposes that individuals who perceive a given health problem as serious are more likely to engage in behaviours to prevent the health problem from occurring (or reduce its severity). Perceived seriousness encompasses beliefs about the disease itself (e.g. whether it is life-threatening or may cause disability or pain) as well as broader impacts of the disease on functioning in work and social roles. For instance, an individual may perceive that influenza is not medically serious, but if he or she perceives that there would be serious financial consequences as a result of being absent from work for several days, then he or she may perceive influenza to be a particularly serious condition.

Through studying Australians and their self-reporting in 2019 of receiving the influenza vaccine, researchers found that by studying perceived severity they could determine the likelihood that Australians would receive the shot. They asked, “On a scale from 0 to 10, how severe do you think the flu would be if you got it?” to measure the perceived severity and they found that 31% perceived the severity of getting the flu as low, 44% as moderate, and 25% as high. Additionally, the researchers found those with a high perceived severity were significantly more likely to have received the vaccine than those with a moderate perceived severity. Furthermore, self-reported vaccination was similar for individuals with low and moderate perceived severity of influenza.

Perceived Benefits

Health-related behaviours are also influenced by the perceived benefits of taking action. Perceived benefits refer to an individual’s assessment of the value or efficacy of engaging in a health-promoting behaviour to decrease risk of disease. If an individual believes that a particular action will reduce susceptibility to a health problem or decrease its seriousness, then he or she is likely to engage in that behaviour regardless of objective facts regarding the effectiveness of the action. For example, individuals who believe that wearing sunscreen prevents skin cancer are more likely to wear sunscreen than individuals who believe that wearing sunscreen will not prevent the occurrence of skin cancer.

Perceived Barriers

Health-related behaviours are also a function of perceived barriers to taking action. Perceived barriers refer to an individual’s assessment of the obstacles to behaviour change. Even if an individual perceives a health condition as threatening and believes that a particular action will effectively reduce the threat, barriers may prevent engagement in the health-promoting behaviour. In other words, the perceived benefits must outweigh the perceived barriers in order for behaviour change to occur. Perceived barriers to taking action include the perceived inconvenience, expense, danger (e.g. side effects of a medical procedure) and discomfort (e.g. pain, emotional upset) involved in engaging in the behaviour. For instance, lack of access to affordable health care and the perception that a flu vaccine shot will cause significant pain may act as barriers to receiving the flu vaccine. In a study about the breast and cervical cancer screening among Hispanic women, perceived barriers, like fear of cancer, embarrassment, fatalistic views of cancer and language, was proved to impede screening.

Modifying Variables

Individual characteristics, including demographic, psychosocial, and structural variables, can affect perceptions (i.e. perceived seriousness, susceptibility, benefits, and barriers) of health-related behaviours. Demographic variables include age, sex, race, ethnicity, and education, among others. Psychosocial variables include personality, social class, and peer and reference group pressure, among others. Structural variables include knowledge about a given disease and prior contact with the disease, among other factors. The HBM suggests that modifying variables affect health-related behaviours indirectly by affecting perceived seriousness, susceptibility, benefits, and barriers.

Cues to Action

The HBM posits that a cue, or trigger, is necessary for prompting engagement in health-promoting behaviours. Cues to action can be internal or external. Physiological cues (e.g. pain, symptoms) are an example of internal cues to action. External cues include events or information from close others, the media, or health care providers promoting engagement in health-related behaviours. Examples of cues to action include a reminder postcard from a dentist, the illness of a friend or family member, mass media campaigns on health issues, and product health warning labels. The intensity of cues needed to prompt action varies between individuals by perceived susceptibility, seriousness, benefits, and barriers. For example, individuals who believe they are at high risk for a serious illness and who have an established relationship with a primary care doctor may be easily persuaded to get screened for the illness after seeing a public service announcement, whereas individuals who believe they are at low risk for the same illness and also do not have reliable access to health care may require more intense external cues in order to get screened.


Self-efficacy was added to the four components of the HBM (i.e. perceived susceptibility, severity, benefits, and barriers) in 1988. Self-efficacy refers to an individual’s perception of his or her competence to successfully perform a behaviour. Self-efficacy was added to the HBM in an attempt to better explain individual differences in health behaviours. The model was originally developed in order to explain engagement in one-time health-related behaviours such as being screened for cancer or receiving an immunisation. Eventually, the HBM was applied to more substantial, long-term behaviour change such as diet modification, exercise, and smoking. Developers of the model recognised that confidence in one’s ability to effect change in outcomes (i.e. self-efficacy) was a key component of health behaviour change. For example, Schmiege et al. found that when dealing with calcium consumption and weight-bearing exercises, self-efficacy was a more powerful predictors than beliefs about future negative health outcomes.

Rosenstock et al. argued that self-efficacy could be added to the other HBM constructs without elaboration of the model’s theoretical structure. However, this was considered short-sighted because related studies indicated that key HBM constructs have indirect effects on behaviour as a result of their effect on perceived control and intention, which might be regarded as more proximal factors of action.

Empirical Support

The HBM has gained substantial empirical support since its development in the 1950s. It remains one of the most widely used and well-tested models for explaining and predicting health-related behaviour. A 1984 review of 18 prospective and 28 retrospective studies suggests that the evidence for each component of the HBMl is strong. The review reports that empirical support for the HBM is particularly notable given the diverse populations, health conditions, and health-related behaviours examined and the various study designs and assessment strategies used to evaluate the model. A more recent meta-analysis found strong support for perceived benefits and perceived barriers predicting health-related behaviours, but weak evidence for the predictive power of perceived seriousness and perceived susceptibility. The authors of the meta-analysis suggest that examination of potential moderated and mediated relationships between components of the model is warranted.

Several studies have provided empirical support from the chronic illness perspective. Becker et al. used the model to predict and explain a mother’s adherence to a diet prescribed for their obese children. Cerkoney et al. interviewed insulin-treated diabetic individuals after diabetic classes at a community hospital. It empirically tested the HBM’s association with the compliance levels of persons chronically ill with diabetes mellitus.


The HBM has been used to develop effective interventions to change health-related behaviours by targeting various aspects of the model’s key constructs. Interventions based on the HBM may aim to increase perceived susceptibility to and perceived seriousness of a health condition by providing education about prevalence and incidence of disease, individualised estimates of risk, and information about the consequences of disease (e.g. medical, financial, and social consequences). Interventions may also aim to alter the cost-benefit analysis of engaging in a health-promoting behaviour (i.e. increasing perceived benefits and decreasing perceived barriers) by providing information about the efficacy of various behaviours to reduce risk of disease, identifying common perceived barriers, providing incentives to engage in health-promoting behaviours, and engaging social support or other resources to encourage health-promoting behaviours. Furthermore, interventions based on the HBM may provide cues to action to remind and encourage individuals to engage in health-promoting behaviours. Interventions may also aim to boost self-efficacy by providing training in specific health-promoting behaviours, particularly for complex lifestyle changes (e.g. changing diet or physical activity, adhering to a complicated medication regimen). Interventions can be aimed at the individual level (i.e. working one-on-one with individuals to increase engagement in health-related behaviours) or the societal level (e.g. through legislation, changes to the physical environment, mass media campaigns).

Multiple studies have used the Health Belief Model to understand an individual’s intention to change a particular behavior and the factors that influence their ability to do so. Researchers analysed the correlation between young adult women’s intention to stop smoking and their perceived factors in the construction of HBM. The intention to stop smoking among young adult women had a significant correlation with the perceived factors of the Health Belief Model.

Another use of the HBM was in 2016 in a study that was interested in examining the factors associated with physical activity among people with mental illness (PMI) in Hong Kong (Mo et al., 2016). The study used the HBM model because it was one of the most frequently used models to explain health behaviours and the HBM was used as a framework to understand the PMI physical activity levels. The study had 443 PMI complete the survey with the mean age being 45 years old. The survey found that among the HBM variables, perceived barriers were significant in predicting physical activity. Additionally, the research demonstrated that self-efficacy had a positive correlation for physical activity among PMI. These findings support previous literature that self-efficacy and perceived barriers plays a significant role in physical activity and it should be included in interventions. The study also stated that the participants acknowledged that most of their attention is focused on their psychiatric conditions with little focus on their physical health needs.

This study is important to note in regards to the HBM because it illustrates how culture can play a role in this model. The Chinese culture holds different health beliefs than the United States, placing a greater emphasis on fate and the balance of spiritual harmony than on their physical fitness. Since the HBM does not consider these outside variables it highlights a limitation associated with the model and how multiple factors can impact health decisions, not just the ones noted in the model.

Applying the Health Belief Model to Women’s Safety Movements

Movements such as the #MeToo movements and current political tensions surrounding abortion laws have moved women’s rights and violence against women to the forefront of topical conversation. Additionally, many organisations, such as Women On Guard, have begun to place emphasize on trying to educate women on what measures to take in order to increase their safety when walking alone at night. The murder of Sarah Everard on 03 March 2021, has placed further attention on the need for women to protect themselves and stay vigilant when walking alone at night. Everard was kidnapped and murdered while walking home from work in South London, England. The health belief model can provide insight into the steps that need to be taken in order to reach more women and convince them to take the necessary steps to increase safety when walking alone.

Perceived Susceptibility

As stated, perceived susceptibility refers to how susceptible an individual perceives themselves to be to any given risk. In the case of encountering violence while walking along, research shows that many women have high amounts of perceived susceptibility in regards to how susceptible they believe themselves to be to the risk of being attacked while walking along. Studies show that around 50% of women feel unsafe when walking alone at night. Since women may already have increased perceive susceptibility to night-violence, according to the health belief model, they may be more apt to engage in behaviour changes to help them increase their safety/ defend themselves.

Perceived Severity

As the statistics on perceived susceptibility demonstrate, many women feel they are at risk for encountering night-violence. Thus, women also have a higher perception of the severity of the violence as stories such as the tragic death of Sarah Everard demonstrate that night-violence attacks can be not only severe, but fatal.

Perceived Benefits and Barriers

As the health belief model states, individuals must consider the potential benefits of adopting the change in behaviour that is being suggested to them. In the case of night-violence against women organisations that seek to prevent it do so by using advertising to demonstrate to women that tools such as pocket knives, pepper spray, self-defence classes, alarm systems, and traveling with a “buddy” can outweigh barriers such as the cost, time, and other inconveniences that pursuing these changes in behaviour may require. The benefit to implementing these behaviours would be that women could feel more safe when walking alone at night.

Modifying Variable

It is not surprise that the modifying variable of sex plays a large role in applying the health belief model to women’s safety agendas/ movements. While studies show that around 50% of women feel unsafe walking at night, they also show that fewer than one fifth of men feel the same fear and discomfort. Thus, it is evident that the modifying variable of gender plays a large role in how night-time violence is perceived. According to the model, women may be more likely to change their behaviour toward preventing night-time violence than men.

Cues to Action

Cues to action are perhaps the most powerful part of the health belief model and of getting individual to change their behaviour. In regards to preventing night-time violence against women, stories of the horrific violent acts committed against women while they are walking at night serve as external cues to action that can spur individuals to take the necessary precautions and make the necessary change to their behaviour in order to reduce the likelihood of them encountering night-time violence. Cues to action further factor into increased perceived susceptibility and severity of the given risk.

Self Efficacy

Self efficacy is another important factor both in the health belief model and in behaviour change in general. When people believe that they actually have the power to prevent the given risk, then they are more likely to take the appropriate measures to do so. When individuals believe that they cannot change their behaviour or prevent the risk no matter what they do, then they are less likely to engage in behaviour to stop the risk. This concept factors greatly into initiatives to help women defend themselves against night violence because, based on the statistics, many women do feel that if they carry items such as tasers, pepper spray, or alarms they will be able to defend themselves against attackers. Self-defence classes are also things that organisations offer in order to teach individuals that they have the power to learn how to defend themselves and acquire the proper skills to do so. These classes can help to increase self efficacy. Organisations such as community centres may offer classes along these lines.

The issues of night violence against women is an issue of safety and wellness which makes it applicable to a health belief model approach. Defence and preparation for night violence can require behavioural changes on behalf of women if they feel that doing so will help them protect themselves should they ever be attacked.


The HBM attempts to predict health-related behaviours by accounting for individual differences in beliefs and attitudes. However, it does not account for other factors that influence health behaviours. For instance, habitual health-related behaviours (e.g. smoking, seatbelt buckling) may become relatively independent of conscious health-related decision-making processes. Additionally, individuals engage in some health-related behaviours for reasons unrelated to health (e.g. exercising for aesthetic reasons). Environmental factors outside an individual’s control may prevent engagement in desired behaviours. For example, an individual living in a dangerous neighbourhood may be unable to go for a jog outdoors due to safety concerns. Furthermore, the HBM does not consider the impact of emotions on health-related behaviour. Evidence suggests that fear may be a key factor in predicting health-related behaviour.

Alternative factors may predict health behaviour, such as outcome expectancy (i.e. whether the person feels they will be healthier as a result of their behaviour) and self-efficacy (i.e. the person’s belief in their ability to carry out preventive behaviour).

The theoretical constructs that constitute the HBM are broadly defined. Furthermore, the HBM does not specify how constructs of the model interact with one another. Therefore, different operationalisations of the theoretical constructs may not be strictly comparable across studies.

Research assessing the contribution of cues to action in predicting health-related behaviours is limited. Cues to action are often difficult to assess, limiting research in this area. For instance, individuals may not accurately report cues that prompted behaviour change. Cues such as a public service announcement on television or on a billboard may be fleeting and individuals may not be aware of their significance in prompting them to engage in a health-related behaviour. Interpersonal influences are also particularly difficult to measure as cues.

Another reason why research does not always support the HBM is that factors other than health beliefs also heavily influence health behaviour practices. These factors may include: special influences, cultural factors, socioeconomic status, and previous experiences. Scholars extend the HBM by adding four more variables (self-identity, perceived importance, consideration of future consequences and concern for appearance) as possible determinants of healthy behaviour. They prove that consideration of future consequences, self-identity, concern for appearance, perceived importance, self-efficacy, perceived susceptibility are significant determinants of healthy eating behaviour that can be manipulated by healthy eating intervention design.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Health_belief_model >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Psychometrics?


Psychometrics is a field of study within psychology concerned with the theory and technique of measurement.

Psychometrics generally refers to specialised fields within psychology and education devoted to testing, measurement, assessment, and related activities. Psychometrics is concerned with the objective measurement of latent constructs that cannot be directly observed. Examples of latent constructs include intelligence, introversion, mental disorders, and educational achievement. The levels of individuals on non-observable latent variables are inferred through mathematical modelling based on what is observed from individuals’ responses to items on tests and scales.

Practitioners are described as psychometricians, although not all who engage in psychometric research go by this title. Psychometricians usually possess specific qualifications such as degrees or certifications, and most are psychologists with advanced graduate training in psychometrics and measurement theory. In addition to traditional, academic institutions, practitioners also work for organisations such as the Educational Testing Service and Psychological Corporation. Some psychometric researchers focus on the construction and validation of assessment instruments including surveys, scales, and open- or close-ended questionnaires. Others focus on research relating to measurement theory (e.g. item response theory; intraclass correlation) or specialise as learning and development professionals.

Historical Foundation

Psychological testing has come from two streams of thought: the first, from Darwin, Galton, and Cattell on the measurement of individual differences, and the second, from Herbart, Weber, Fechner, and Wundt and their psychophysical measurements of a similar construct. The second set of individuals and their research is what has led to the development of experimental psychology and standardised testing.

Victorian Stream

Charles Darwin was the inspiration behind Sir Francis Galton, a scientist who advanced the development of psychometrics. In 1859, Darwin published his book On the Origin of Species. Darwin described the role of natural selection in the emergence, over time, of different populations of species of plants and animals. The book showed how individual members of a species differ among themselves and how they possess characteristics that are more or less adaptive to their environment. Those with more adaptive characteristics are more likely to survive to procreate and give rise to another generation. Those with less adaptive characteristics are less likely. These ideas stimulated Galton’s interest in the study of human beings and how they differ one from another and, more importantly, how to measure those differences.

Galton wrote a book entitled Hereditary Genius. The book described different characteristics that people possess and how those characteristics make some more “fit” than others. Today these differences, such as sensory and motor functioning (reaction time, visual acuity, and physical strength), are important domains of scientific psychology. Much of the early theoretical and applied for work in psychometrics was undertaken in an attempt to measure intelligence. Galton often referred to as “the father of psychometrics,” devised and included mental tests among his anthropometric measures. James McKeen Cattell, a pioneer in the field of psychometrics, went on to extend Galton’s work. Cattell coined the term mental test, and is responsible for research and knowledge that ultimately led to the development of modern tests.

German Stream

The origin of psychometrics also has connections to the related field of psychophysics. Around the same time that Darwin, Galton, and Cattell were making their discoveries, Herbart was also interested in “unlocking the mysteries of human consciousness” through the scientific method. Herbart was responsible for creating mathematical models of the mind, which were influential in educational practices for years to come.

E.H. Weber built upon Herbart’s work and tried to prove the existence of a psychological threshold, saying that a minimum stimulus was necessary to activate a sensory system. After Weber, G.T. Fechner expanded upon the knowledge he gleaned from Herbart and Weber, to devise the law that the strength of a sensation grows as the logarithm of the stimulus intensity. A follower of Weber and Fechner, Wilhelm Wundt is credited with founding the science of psychology. It is Wundt’s influence that paved the way for others to develop psychological testing.

20th Century

In 1936, the psychometrician L.L. Thurstone, founder and first president of the Psychometric Society, developed and applied a theoretical approach to measurement referred to as the law of comparative judgement, an approach that has close connections to the psychophysical theory of Ernst Heinrich Weber and Gustav Fechner. In addition, Spearman and Thurstone both made important contributions to the theory and application of factor analysis, a statistical method developed and used extensively in psychometrics. In the late 1950s, Leopold Szondi made a historical and epistemological assessment of the impact of statistical thinking on psychology during previous few decades: “in the last decades, the specifically psychological thinking has been almost completely suppressed and removed, and replaced by a statistical thinking. Precisely here we see the cancer of testology and testomania of today.”

More recently, psychometric theory has been applied in the measurement of personality, attitudes, and beliefs, and academic achievement. These latent constructs cannot truly be measured, and much of the research and science in this discipline has been developed in an attempt to measure these constructs as close to the true score as possible.

Figures who made significant contributions to psychometrics include Karl Pearson, Henry F. Kaiser, Carl Brigham, L.L. Thurstone, E.L. Thorndike, Georg Rasch, Eugene Galanter, Johnson O’Connor, Frederic M. Lord, Ledyard R. Tucker, Louis Guttman, and Jane Loevinger.

Definition of Measurement in the Social Sciences

The definition of measurement in the social sciences has a long history. A current widespread definition, proposed by Stanley Smith Stevens, is that measurement is “the assignment of numerals to objects or events according to some rule.” This definition was introduced in a 1946 Science article in which Stevens proposed four levels of measurement. Although widely adopted, this definition differs in important respects from the more classical definition of measurement adopted in the physical sciences, namely that scientific measurement entails “the estimation or discovery of the ratio of some magnitude of a quantitative attribute to a unit of the same attribute.”

Indeed, Stevens’s definition of measurement was put forward in response to the British Ferguson Committee, whose chair, A. Ferguson, was a physicist. The committee was appointed in 1932 by the British Association for the Advancement of Science to investigate the possibility of quantitatively estimating sensory events. Although its chair and other members were physicists, the committee also included several psychologists. The committee’s report highlighted the importance of the definition of measurement. While Stevens’s response was to propose a new definition, which has had considerable influence in the field, this was by no means the only response to the report. Another, notably different, response was to accept the classical definition, as reflected in the following statement:

Measurement in psychology and physics are in no sense different. Physicists can measure when they can find the operations by which they may meet the necessary criteria; psychologists have to do the same. They need not worry about the mysterious differences between the meaning of measurement in the two sciences. (Reese, 1943, p.49).

These divergent responses are reflected in alternative approaches to measurement. For example, methods based on covariance matrices are typically employed on the premise that numbers, such as raw scores derived from assessments, are measurements. Such approaches implicitly entail Stevens’s definition of measurement, which requires only that numbers are assigned according to some rule. The main research task, then, is generally considered to be the discovery of associations between scores, and of factors posited to underlie such associations.

On the other hand, when measurement models such as the Rasch model are employed, numbers are not assigned based on a rule. Instead, in keeping with Reese’s statement above, specific criteria for measurement are stated, and the goal is to construct procedures or operations that provide data that meet the relevant criteria. Measurements are estimated based on the models, and tests are conducted to ascertain whether the relevant criteria have been met.

Instruments and Procedures

The first psychometric instruments were designed to measure intelligence. One early approach to measuring intelligence was the test developed in France by Alfred Binet and Theodore Simon. That test was known as the Test Binet-Simon .The French test was adapted for use in the US by Lewis Terman of Stanford University, and named the Stanford-Binet IQ test.

Another major focus in psychometrics has been on personality testing. There has been a range of theoretical approaches to conceptualizing and measuring personality, though there is no widely agreed upon theory. Some of the better-known instruments include the Minnesota Multiphasic Personality Inventory, the Five-Factor Model (or “Big 5”) and tools such as Personality and Preference Inventory and the Myers-Briggs Type Indicator. Attitudes have also been studied extensively using psychometric approaches. An alternative method involves the application of unfolding measurement models, the most general being the Hyperbolic Cosine Model (Andrich & Luo, 1993).

Theoretical Approaches

Psychometricians have developed a number of different measurement theories. These include classical test theory (CTT) and item response theory (IRT). An approach that seems mathematically to be similar to IRT but also quite distinctive, in terms of its origins and features, is represented by the Rasch model for measurement. The development of the Rasch model, and the broader class of models to which it belongs, was explicitly founded on requirements of measurement in the physical sciences.

Psychometricians have also developed methods for working with large matrices of correlations and covariances. Techniques in this general tradition include: factor analysis, a method of determining the underlying dimensions of data. One of the main challenges faced by users of factor analysis is a lack of consensus on appropriate procedures for determining the number of latent factors. A usual procedure is to stop factoring when eigenvalues drop below one because the original sphere shrinks. The lack of the cutting points concerns other multivariate methods, also.

Multidimensional scaling is a method for finding a simple representation for data with a large number of latent dimensions. Cluster analysis is an approach to finding objects that are like each other. Factor analysis, multidimensional scaling, and cluster analysis are all multivariate descriptive methods used to distil from large amounts of data simpler structures.

More recently, structural equation modelling and path analysis represent more sophisticated approaches to working with large covariance matrices. These methods allow statistically sophisticated models to be fitted to data and tested to determine if they are adequate fits. Because at a granular level psychometric research is concerned with the extent and nature of multidimensionality in each of the items of interest, a relatively new procedure known as bi-factor analysis can be helpful. Bi-factor analysis can decompose “an item’s systematic variance in terms of, ideally, two sources, a general factor and one source of additional systematic variance.”

Key Concepts

Key concepts in classical test theory are reliability and validity. A reliable measure is one that measures a construct consistently across time, individuals, and situations. A valid measure is one that measures what it is intended to measure. Reliability is necessary, but not sufficient, for validity.

Both reliability and validity can be assessed statistically. Consistency over repeated measures of the same test can be assessed with the Pearson correlation coefficient, and is often called test-retest reliability. Similarly, the equivalence of different versions of the same measure can be indexed by a Pearson correlation, and is called equivalent forms reliability or a similar term.

Internal consistency, which addresses the homogeneity of a single test form, may be assessed by correlating performance on two halves of a test, which is termed split-half reliability; the value of this Pearson product-moment correlation coefficient for two half-tests is adjusted with the Spearman-Brown prediction formula to correspond to the correlation between two full-length tests. Perhaps the most commonly used index of reliability is Cronbach’s α, which is equivalent to the mean of all possible split-half coefficients. Other approaches include the intra-class correlation, which is the ratio of variance of measurements of a given target to the variance of all targets.

There are a number of different forms of validity. Criterion-related validity refers to the extent to which a test or scale predicts a sample of behaviour, i.e. the criterion, that is “external to the measuring instrument itself.” That external sample of behaviour can be many things including another test; college grade point average as when the high school SAT is used to predict performance in college; and even behaviour that occurred in the past, for example, when a test of current psychological symptoms is used to predict the occurrence of past victimisation (which would accurately represent postdiction). When the criterion measure is collected at the same time as the measure being validated the goal is to establish concurrent validity; when the criterion is collected later the goal is to establish predictive validity. A measure has construct validity if it is related to measures of other constructs as required by theory. Content validity is a demonstration that the items of a test do an adequate job of covering the domain being measured. In a personnel selection example, test content is based on a defined statement or set of statements of knowledge, skill, ability, or other characteristics obtained from a job analysis.

Item response theory models the relationship between latent traits and responses to test items. Among other advantages, IRT provides a basis for obtaining an estimate of the location of a test-taker on a given latent trait as well as the standard error of measurement of that location. For example, a university student’s knowledge of history can be deduced from his or her score on a university test and then be compared reliably with a high school student’s knowledge deduced from a less difficult test. Scores derived by classical test theory do not have this characteristic, and assessment of actual ability (rather than ability relative to other test-takers) must be assessed by comparing scores to those of a “norm group” randomly selected from the population. In fact, all measures derived from classical test theory are dependent on the sample tested, while, in principle, those derived from item response theory are not.

Standards of Quality

The considerations of validity and reliability typically are viewed as essential elements for determining the quality of any test. However, professional and practitioner associations frequently have placed these concerns within broader contexts when developing standards and making overall judgements about the quality of any test as a whole within a given context. A consideration of concern in many applied research settings is whether or not the metric of a given psychological inventory is meaningful or arbitrary.

Testing Standards

In 2014, the American Educational Research Association (AERA), American Psychological Association (APA), and National Council on Measurement in Education (NCME) published a revision of the Standards for Educational and Psychological Testing, which describes standards for test development, evaluation, and use. The Standards cover essential topics in testing including validity, reliability/errors of measurement, and fairness in testing. The book also establishes standards related to testing operations including test design and development, scores, scales, norms, score linking, cut scores, test administration, scoring, reporting, score interpretation, test documentation, and rights and responsibilities of test takers and test users. Finally, the Standards cover topics related to testing applications, including psychological testing and assessment, workplace testing and credentialing, educational testing and assessment, and testing in programme evaluation and public policy.

Evaluation Standards

In the field of evaluation, and in particular educational evaluation, the Joint Committee on Standards for Educational Evaluation has published three sets of standards for evaluations. The Personnel Evaluation Standards was published in 1988, The Program Evaluation Standards (2nd edition) was published in 1994, and The Student Evaluation Standards was published in 2003.

Each publication presents and elaborates a set of standards for use in a variety of educational settings. The standards provide guidelines for designing, implementing, assessing, and improving the identified form of evaluation. Each of the standards has been placed in one of four fundamental categories to promote educational evaluations that are proper, useful, feasible, and accurate. In these sets of standards, validity and reliability considerations are covered under the accuracy topic. For example, the student accuracy standards help ensure that student evaluations will provide sound, accurate, and credible information about student learning and performance.

Controversy and Criticism

Because psychometrics is based on latent psychological processes measured through correlations, there has been controversy about some psychometric measures. Critics, including practitioners in the physical sciences, have argued that such definition and quantification is difficult, and that such measurements are often misused by laymen, such as with personality tests used in employment procedures. The Standards for Educational and Psychological Measurement gives the following statement on test validity: “validity refers to the degree to which evidence and theory support the interpretations of test scores entailed by proposed uses of tests”. Simply put, a test is not valid unless it is used and interpreted in the way it is intended.

Two types of tools used to measure personality traits are objective tests and projective measures. Examples of such tests are the: Big Five Inventory (BFI), Minnesota Multiphasic Personality Inventory (MMPI-2), Rorschach Inkblot test, Neurotic Personality Questionnaire KON-2006, or Eysenck’s Personality Questionnaire (EPQ-R). Some of these tests are helpful because they have adequate reliability and validity, two factors that make tests consistent and accurate reflections of the underlying construct. The Myers-Briggs Type Indicator (MBTI), however, has questionable validity and has been the subject of much criticism. Psychometric specialist Robert Hogan wrote of the measure: “Most personality psychologists regard the MBTI as little more than an elaborate Chinese fortune cookie.”

Lee Cronbach noted in American Psychologist (1957) that, “correlational psychology, though fully as old as experimentation, was slower to mature. It qualifies equally as a discipline, however, because it asks a distinctive type of question and has technical methods of examining whether the question has been properly put and the data properly interpreted.” He would go on to say, “The correlation method, for its part, can study what man has not learned to control or can never hope to control … A true federation of the disciplines is required. Kept independent, they can give only wrong answers or no answers at all regarding certain important problems.”

Non-Human: Animals and Machines

Psychometrics addresses human abilities, attitudes, traits, and educational evolution. Notably, the study of behaviour, mental processes, and abilities of non-human animals is usually addressed by comparative psychology, or with a continuum between non-human animals and the rest of animals by evolutionary psychology. Nonetheless, there are some advocators for a more gradual transition between the approach taken for humans and the approach taken for (non-human) animals.

The evaluation of abilities, traits and learning evolution of machines has been mostly unrelated to the case of humans and non-human animals, with specific approaches in the area of artificial intelligence. A more integrated approach, under the name of universal psychometrics, has also been proposed.

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What is the Eysenck Personality Questionnaire?


In psychology, the Eysenck Personality Questionnaire (EPQ) is a questionnaire to assess the personality traits of a person. It was devised by psychologists Hans Jürgen Eysenck and Sybil B.G. Eysenck.

Hans Eysenck’s theory is based primarily on physiology and genetics. Although he was a behaviourist who considered learned habits of great importance, he believed that personality differences are determined by genetic inheritance. He is, therefore, primarily interested in temperament. In devising a temperament-based theory, Eysenck did not exclude the possibility that some aspects of personality are learned, but left the consideration of these to other researchers.


Eysenck initially conceptualised personality as two biologically-based independent dimensions of temperament, E and N, measured on a continuum, but then extending this to include a third, P.

E – Extraversion/Introversion

  • Extraversion is characterised by being outgoing, talkative, high on positive affect (feeling good), and in need of external stimulation.
  • According to Eysenck’s arousal theory of extraversion, there is an optimal level of cortical arousal, and performance deteriorates as one becomes more or less aroused than this optimal level.
  • Arousal can be measured by skin conductance, brain waves or sweating.
  • At very low and very high levels of arousal, performance is low, but at a better mid-level of arousal, performance is maximised.
  • Extraverts, according to Eysenck’s theory, are chronically under-aroused and bored and are therefore in need of external stimulation to bring them UP to an optimal level of performance.
  • About 16% of the population tend to fall in this range.
  • Introverts, on the other hand, (also about 16 percent of the population) are chronically over-aroused and jittery and are therefore in need of peace and quietness to bring them DOWN to an optimal level of performance.
  • Most people (about 68% of the population) fall in the midrange of the extraversion/introversion continuum, an area referred to as ambiversion.

N – Neuroticism/Stability

  • Neuroticism or emotionality is characterised by high levels of negative affect such as depression and anxiety.
  • Neuroticism, according to Eysenck’s theory, is based on activation thresholds in the sympathetic nervous system or visceral brain.
  • This is the part of the brain that is responsible for the fight-or-flight response in the face of danger.
  • Activation can be measured by heart rate, blood pressure, cold hands, sweating and muscular tension (especially in the forehead).
  • Neurotic people – who have low activation thresholds, and unable to inhibit or control their emotional reactions, experience negative affect (fight-or-flight) in the face of very minor stressors – are easily nervous or upset.
  • Emotionally stable people – who have high activation thresholds and good emotional control, experience negative affect only in the face of very major stressors – are calm and collected under pressure.

The two dimensions or axes, extraversion-introversion and emotional stability-instability, define four quadrants. These are made up of:

  • Stable extraverts (sanguine qualities such as outgoing, talkative, responsive, easy going, lively, carefree, leadership).
  • Unstable extraverts (choleric qualities such as touchy, restless, excitable, changeable, impulsive, irresponsible).
  • Stable introverts (phlegmatic qualities such as calm, even-tempered, reliable, controlled, peaceful, thoughtful, careful, passive).
  • Unstable introverts (melancholic qualities such as quiet, reserved, pessimistic, sober, rigid, anxious, moody).

Further research demonstrated the need for a third category of temperament:

P – Psychoticism/Socialisation

  • Psychoticism is associated not only with the liability to have a psychotic episode (or break with reality), but also with aggression.
  • Psychotic behaviour is rooted in the characteristics of toughmindedness, non-conformity, inconsideration, recklessness, hostility, anger and impulsiveness.
  • The physiological basis suggested by Eysenck for psychoticism is testosterone, with higher levels of psychoticism associated with higher levels of testosterone.

The following table describes the traits that are associated with the three dimensions in Eysenck’s model of personality.

EgocentricDominantGuilt Feelings
UnsympatheticLack of ReflectionLow Self-Esteem
MasculineExpressiveLack of Autonomy

L – Lie/Social Desirability

Although the first 3 scales were predicted upon a biologically based theory of personality, the fourth scale has not been theoretically specified to the same extent, but it was considered to be conceptually strong to the extent that it would demonstrate the same degree of measurement similarity across cultures.


Since the re-evaluation of Eysenck’s work in the 21st century, amidst revelations of data fabrication or fraud committed by Eysenck, the Eysenck Personality Questionnaire has itself come under scrutiny as potentially biased, flawed, or based upon faulty data.


EPQ also exists in Finnish and Turkish versions.

In 1985 a revised version of EPQ was described – the EPQ-R – with a publication in the journal Personality and Individual Differences. This version has 100 yes/no questions in its full version and 48 yes/no questions in its short scale version. A different approach to personality measurement developed by Eysenck, which distinguishes between different facets of these traits, is the Eysenck Personality Profiler.

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What is Flow (Psychology)?


In positive psychology, a flow state, also known colloquially as being in the zone, is the mental state in which a person performing some activity is fully immersed in a feeling of energised focus, full involvement, and enjoyment in the process of the activity. In essence, flow is characterised by the complete absorption in what one does, and a resulting transformation in one’s sense of time.

Named by the psychologist Mihály Csíkszentmihályi in 1975, the concept has been widely referred to across a variety of fields (and is particularly well recognised in occupational therapy), though the concept has been claimed to have existed for thousands of years under other names.

The flow state shares many characteristics with hyperfocus. However, hyperfocus is not always described in a positive light. Some examples include spending “too much” time playing video games or becoming pleasurably absorbed by one aspect of an assignment or task to the detriment of the overall assignment. In some cases, hyperfocus can “capture” a person, perhaps causing them to appear unfocused or to start several projects, but complete few. Hyperfocus is often mentioned “in the context of autism, schizophrenia, and attention deficit hyperactivity disorder – conditions that have consequences on attentional abilities.”


Jeanne Nakamura and Csíkszentmihályi identify the following six factors as encompassing an experience of flow:

  • Intense and focused concentration on the present moment.
  • Merging of action and awareness.
  • A loss of reflective self-consciousness.
  • A sense of personal control or agency over the situation or activity.
  • A distortion of temporal experience, as one’s subjective experience of time is altered.
  • Experience of the activity as intrinsically rewarding, also referred to as autotelic experience.

Those aspects can appear independently of each other, but only in combination do they constitute a so-called flow experience. Additionally, psychology writer Kendra Cherry has mentioned three other components that Csíkszentmihályi lists as being a part of the flow experience:

  • Immediate feedback.
  • Feeling the potential to succeed.
  • Feeling so engrossed in the experience, that other needs become negligible.

Just as with the conditions listed above, these conditions can be independent of one another.


Flow is so named because, during Csíkszentmihályi’s 1975 interviews, several people described their “flow” experiences using the metaphor of a water current carrying them along: “‘It was like floating,’ ‘I was carried on by the flow.'”

Brief History

Mihaly Csikszentmihályi and others began researching flow after Csikszentmihályi became fascinated by artists who would essentially get lost in their work. Artists, especially painters, got so immersed in their work that they would disregard their need for food, water and even sleep. The theory of flow came about when Csikszentmihályi tried to understand the phenomenon experienced by these artists. Flow research became prevalent in the 1980s and 1990s, with Csikszentmihályi and his colleagues in Italy still at the forefront. Researchers interested in optimal experiences and emphasizing positive experiences, especially in places such as schools and the business world, also began studying the theory of flow at this time.

The cognitive science of flow has been studied under the rubric of effortless attention.


In any given moment, there is a great deal of information made available to each individual. Psychologists have found that one’s mind can attend to only a certain amount of information at a time. According to Csikszentmihályi’s 2004 TED talk, that number is about “110 bits of information per second.” That may seem like a lot of information, but simple daily tasks take quite a lot of information. Just decoding speech takes about 40-60 bits of information per second, which is why when having a conversation, one cannot focus as much attention on other things.

For the most part (except for basic bodily feelings like hunger and pain, which are innate), people are able to decide what they want to focus their attention on. However, when one is in the flow state, they are completely engrossed with the one task at hand and, without making the conscious decision to do so, lose awareness of all other things: time, people, distractions, and even basic bodily needs. According to Csikszentmihályi, this event occurs because all of the attention of the person in the flow state is on the task at hand; there is no more attention to be allocated.

The flow state has been described by Csikszentmihályi as the “optimal experience” in that one gets to a level of high gratification from the experience. Achieving this experience is considered to be personal and “depends on the ability” of the individual. One’s capacity and desire to overcome challenges in order to achieve their ultimate goals leads not only to the optimal experience but also to a sense of life satisfaction overall.


There are three common ways to measure flow experiences: the flow questionnaire (FQ), the experience sampling method (ESM), and the “standardised scales of the componential approach.”

Flow Questionnaire

The FQ requires individuals to identify definitions of flow and situations in which they believe that they have experienced flow, followed by a section that asks them to evaluate their personal experiences in these flow-inducing situations. The FQ identifies flow as multiple constructs, therefore allowing the results to be used to estimate differences in the likelihood of experiencing flow across a variety of factors. Another strength of the FQ is that it does not assume that everyone’s flow experiences are the same. Because of this, the FQ is the ideal measure for estimating the prevalence of flow. However, the FQ has some weaknesses that more recent methods have set out to address. The FQ does not allow for a measurement of the intensity of flow during specific activities. This method also does not measure the influence of the ratio of challenge to skill on the flow state.

Experience Sampling Method

The ESM requires individuals to fill out the experience sampling form (ESF) at eight randomly chosen time intervals throughout the day. The purpose of this is to understand subjective experiences by estimating the time intervals that individuals spend in specific states during everyday life. The ESF is made up of 13 categorical items and 29 scaled items. The purpose of the categorical items is to determine the context and motivational aspects of the current actions (these items include: time, location, companionship/desire for companionship, activity being performed, reason for performing activity). Because these questions are open-ended, the answers need to be coded by researchers. This needs to be done carefully so as to avoid any biases in the statistical analysis. The scaled items are intended to measure the levels of a variety of subjective feelings that the individual may be experiencing. The ESM is more complex than the FQ and contributes to the understanding of how flow plays out in a variety of situations, however the possible biases make it a risky choice.

Standardised Scales

Some researchers are not satisfied with the methods mentioned above and have set out to create their own scales. The scales developed by Jackson and Eklund are the most commonly used in research, mainly because they are still consistent with Csíkszentmihályi’s definition of flow and consider flow as being both a state and a trait. Jackson and Eklund created two scales that have been proven to be psychometrically valid and reliable:

  • The flow state scale-2 (which measures flow as a state); and
  • The dispositional flow scale-2 (designed to measure flow as either a general trait or domain-specific trait).

The statistical analysis of the individual results from these scales gives a much more complete understanding of flow than the ESM and the FQ.


The flow state can be entered while performing any activity, although it is more likely to occur when the task or activity is wholeheartedly engaged for intrinsic purposes. Passive activities such as taking a bath or even watching TV, usually do not elicit a flow experience because active engagement is prerequisite to entering the flow state. While the activities that induce flow vary and may perhaps be multifaceted, Csikszentmihályi asserts that the experience of flow is similar whatever the activity.

Flow theory postulates that three conditions must be met to achieve flow:

  • The activity must have clear goals and progress. This establishes structure and direction.
  • The task must provide clear and immediate feedback. This helps to negotiate any changing demands and allows adjusting performance to maintain the flow state.
  • Good balance is required between the perceived challenges of the task and one’s perceived skills. Confidence in the ability to complete the task is required.

It has been argued that the antecedent factors of flow are interrelated, and as such, a perceived balance between challenges and skills requires that the goals are clear, and feedback is effective. Thus, the coordination of perceived demands and task skills can be identified as the central precondition of flow experience.

In 1987, Massimini, Csíkszentmihályi and Carli published the eight-channel model of flow. Antonella Delle Fave, who worked with Fausto Massimini at the University of Milan, calls this graph the Experience Fluctuation Model. The model depicts the channels of experience that result from different levels of perceived challenges and perceived skills. The graph illustrates another aspect of flow: it is more likely to occur when the activity is a higher-than-average challenge (above the centre point) and the individual has above-average skills (to the right of the centre point). The centre of the graph where the sectors meet represents the average level of challenge and skill across all individual daily activities. The further from the centre an experience is, the greater the intensity of that state of being, whether it is flow or anxiety or boredom or relaxation.

Several problems of the model have been discussed in literature. One is that it does not ensure the perceived balance between challenges and skills which is said to be the central precondition of flow experience. Individuals with a low average level of skills and a high average level of challenges (or the converse) do not necessarily experience a match between skills and challenges when both are above their individual average. Another study found that low challenge situations which were surpassed by skill were associated with enjoyment, relaxation, and happiness, which, they claim, is contrary to flow theory.

Schaffer (2013) proposed seven flow conditions:

  • Knowing what to do.
  • Knowing how to do it.
  • Knowing how well one is doing.
  • Knowing where to go (if navigation is involved).
  • High perceived challenges.
  • High perceived skills.
  • Freedom from distractions.

Schaffer published a flow condition questionnaire (FCQ), to measure each of these seven flow conditions for any given task or activity.

Challenges to Maintaining Flow

Some of the challenges to staying in flow include states of apathy, boredom, and anxiety. The state of apathy is characterized by easy challenges and low skill level requirements, resulting in a general lack of interest in the activity. Boredom is a slightly different state that occurs when challenges are few, but one’s skill level exceeds those challenges causing one to seek higher challenges. A state of anxiety occurs when challenges are high enough to exceed perceived skill level, causing distress and uneasiness. These states in general prevent achieving the balance necessary for flow. Csíkszentmihályi has said, “If challenges are too low, one gets back to flow by increasing them. If challenges are too great, one can return to the flow state by learning new skills.”

The Autotelic Personality

Csíkszentmihályi hypothesized that people with certain personality traits may be better able to achieve flow than the average person. These traits include curiosity, persistence, low egotism, and a high propensity to perform activities for intrinsic reasons. People with most of these personality traits are said to have an autotelic personality. The term “autotelic” derives from two Greek words, auto, meaning self, and telos meaning goal. Being autotelic means having a self-contained activity, without the expectation of future benefit, but simply to be experienced.

There is scant research on the autotelic personality, but results of the few studies that have been conducted suggest that indeed some people are more likely to experience flow than others. One researcher (Abuhamdeh, 2000) found that people with an autotelic personality have a greater preference for “high-action-opportunity, high-skills situations that stimulate them and encourage growth” compared to those without an autotelic personality. It is in such high-challenge, high-skills situations that people are most likely to experience flow.

Experimental evidence shows that a balance between individual skills, and demands of the task (compared to boredom and overload) only elicits the flow experience in individuals having an internal locus of control or a habitual action orientation. Several correlational studies found need for achievement to be a personal characteristic that fosters flow experiences.

Autotelic Personality also has been shown in studies to correlate and show overlapping of flow in personal life and the Big Five Personality Traits of Extraversion, Agreeableness, Conscientiousness, Neuroticism, and Openness to Experience. More particularly the traits of agreeableness and extraversion. Study of Autotelic Personality is difficult as most studies are performed through self-evaluation as observation of an Autotelic Personality is difficult to observe.


Group flow (or team flow) is notably different from independent flow as it is inherently mutual. Group flow is attainable when the performance unit is a group, such as a team or musical group. When groups cooperate to agree on goals and patterns, social flow, commonly known as group cohesion, is much more likely to occur. If a group still has not entered flow, a team-level challenge may stimulate the group to harmonise.


Applications Suggested by Csíkszentmihályi versus Other Practitioners

Only Csíkszentmihályi seems to have published suggestions for extrinsic applications of the flow concept, such as design methods for playgrounds to elicit the flow experience. Other practitioners of Csíkszentmihályi’s flow concept focus on intrinsic applications, such as spirituality, performance improvement, or self-help. His work has also informed the measurement of donor momentum by The New Science of Philanthropy.


In education, the concept of overlearning plays a role in a student’s ability to achieve flow. Csíkszentmihályi states that overlearning enables the mind to concentrate on visualising the desired performance as a singular, integrated action instead of a set of actions. Challenging assignments that (slightly) stretch one’s skills lead to flow.

In the 1950s British cybernetician Gordon Pask designed an adaptive teaching machine called SAKI, an early example of “e-learning”. The machine is discussed in some detail in Stafford Beer’s book “Cybernetics and Management”. In the patent application for SAKI (1956), Pask’s comments (some of which are included below) indicate an awareness of the pedagogical importance of balancing student competence with didactic challenge, which is quite consistent with flow theory:

If the operator is receiving data at too slow a rate, he is likely to become bored and attend to other irrelevant data.

If the data given indicates too precisely what responses the operator is required to make, the skill becomes too easy to perform and the operator again tends to become bored.

If the data given is too complicated or is given at too great a rate, the operator is unable to deal with it. He is then liable to become discouraged and lose interest in performing or learning the skill.

Ideally, for an operator to perform a skill efficiently, the data presented to him should always be of sufficient complexity to maintain his interest and maintain a competitive situation, but not so complex as to discourage the operator. Similarly these conditions should obtain at each stage of a learning process if it is to be efficient. A tutor teaching one pupil seeks to maintain just these conditions.

Around 2000, it came to the attention of Csíkszentmihályi that the principles and practices of the Montessori Method of education seemed to purposefully set up continuous flow opportunities and experiences for students. Csíkszentmihályi and psychologist Kevin Rathunde embarked on a multi-year study of student experiences in Montessori settings and traditional educational settings. The research supported observations that students achieved flow experiences more frequently in Montessori settings.


Musicians, especially improvisational soloists, may experience a state of flow while playing their instrument. Research has shown that performers in a flow state have a heightened quality of performance as opposed to when they are not in a flow state. In a study performed with professional classical pianists who played piano pieces several times to induce a flow state, a significant relationship was found between the flow state of the pianist and the pianist’s heart rate, blood pressure, and major facial muscles. As the pianist entered the flow state, heart rate and blood pressure decreased, and the major facial muscles relaxed. This study further emphasized that flow is a state of effortless attention. In spite of the effortless attention and overall relaxation of the body, the performance of the pianist during the flow state improved.

Groups of drummers go through a state of flow when they sense a collective energy that drives the beat, something they refer to as getting into the groove or entrainment. Likewise, drummers and bass guitarists often describe a state of flow when they are feeling the downbeat together as being in the pocket. Researchers have measured flow through subscales; challenge-skill balance, merging of action and awareness, clear goals, unambiguous feedback, total concentration, sense of control, loss of self-consciousness, transformation of time and autotelic experience.


The concept of being in the zone during an athletic performance fit within Csíkszentmihályi’s description of the flow experience, and theories and applications of being in the zone and its relationship with an athletic competitive advantage are topics studied in the field of sport psychology.

Timothy Gallwey’s influential works on the “inner game” of sports such as golf and tennis described the mental coaching and attitudes required to “get in the zone” and fully internalise mastery of the sport.

Roy Palmer suggests that “being in the zone” may also influence movement patterns as better integration of the conscious and subconscious reflex functions improves coordination. Many athletes describe the effortless nature of their performance while achieving personal bests.

In many martial arts, the term Budō is used to describe psychological flow. Mixed martial arts champion and Karate master Lyoto Machida uses meditation techniques before fights to attain mushin, a concept that, by his description, is in all respects equal to flow.

The Formula One driver Ayrton Senna, during qualifying for the 1988 Monaco Grand Prix, explained:

“I was already on pole, […] and I just kept going. Suddenly I was nearly two seconds faster than anybody else, including my team mate with the same car. And suddenly I realised that I was no longer driving the car consciously. I was driving it by a kind of instinct, only I was in a different dimension. It was like I was in a tunnel.”

Former 500 GP rider Wayne Gardner talking about his victory at the 1990 Australian Grand Prix on The Unrideables 2 documentary said: “During these last five laps I had this sort of above body experience where actually raised up above and I could see myself racing. It was kind of a remote control and it’s the weirdest thing I’ve ever had in my life. […]” After the race Mick [Doohan] and in fact Wayne Rainey said: “How the hell did you do that?” and I said: “I have no idea.”

Religion and Spirituality

In yogic traditions such as Raja Yoga, reference is made to a state of flow in the practice of Samyama, a psychological absorption in the object of meditation.

Games and Gaming

Flow in games and gaming has been linked to the laws of learning as a part of the explanation for why learning-games (the use of games to introduce material, improve understanding, or increase retention) have the potential to be effective. In particular, flow is intrinsically motivating, which is a part of the law of readiness. The condition of feedback, required for flow, is associated with the feedback aspects of the law of exercise. This is exhibited in well designed games, in particular, where players perform at the edge of their competency as they are guided by clear goals and feedback. The positive emotions associated with flow are associated with the law of effect. The intense experiences of being in a state of flow are directly associated with the law of intensity. Thus, the experience of gaming can be so engaging and motivating as it meets many of the laws of learning, which are inextricably connected to creating flow.

In games often much can be achieved thematically through an imbalance between challenge level and skill level. Horror games often keep challenges significantly above the player’s level of competency in order to foster a continual feeling of anxiety. Conversely, so called “relaxation games” keep the level of challenges significantly below the player’s competency level, in order to achieve an opposite effect. The video game Flow was designed as part of Jenova Chen’s master’s thesis for exploring the design decisions that allow players to achieve the flow state, by adjusting the difficulty dynamically during play.

It improves performance; calling the phenomenon “TV trance,” a 1981 BYTE article discussed how “the best seem to enter a trance where they play but don’t pay attention to the details of the game.” The primary goal of games is to create entertainment through intrinsic motivation, which is related to flow; that is, without intrinsic motivation it is virtually impossible to establish flow. Through the balance of skill and challenge, the player’s brain is aroused, with attention engaged and motivation high. Thus, the use of flow in games helps foster an enjoyable experience, which in turn increases motivation and draws players to continue playing. As such, game designers strive to integrate flow principles into their projects. Overall, the experience of play is fluid and is intrinsically psychologically rewarding independent of scores or in-game successes in the flow state.

Design of Intrinsically Motivated Computer Systems

A simplified modification to flow has been combined with the technology acceptance model (TAM) to help guide the design of and explain the adoption of intrinsically motivated computer systems. This model, the hedonic-motivation system adoption model (HMSAM) is modelled to improve the understanding of hedonic-motivation systems (HMS) adoption. HMS are systems used primarily to fulfil users’ intrinsic motivations, such for online gaming, virtual worlds, online shopping, learning/education, online dating, digital music repositories, social networking, online pornography, gamified systems, and for general gamification. Instead of a minor, TAM extension, HMSAM is an HMS-specific system acceptance model based on an alternative theoretical perspective, which is in turn grounded in flow-based concept of cognitive absorption (CA). The HMSAM further builds on van der Heijden’s (2004) model of hedonic system adoption by including CA as a key mediator of perceived ease of use (PEOU) and of behavioural intentions to use (BIU) hedonic-motivation systems. Typically, models simplistically represent “intrinsic motivations” by mere perceived enjoyed. Instead, HMSAM uses the more complex, rich construct of CA, which includes joy, control, curiosity, focused immersion, and temporal dissociation. CA is construct that is grounded in the seminal flow literature, yet CA has traditionally been used as a static construct, as if all five of its subconstructs occur at the same time – in direct contradiction to the flow literature. Thus, part of HMSAM’s contribution is to return CA closer to its flow roots by re-ordering these CA subconstructs into more natural process-variance order as predicted by flow. Empirical data collection along with mediation tests further support this modelling approach.

Professions and Work

Developers of computer software reference getting into a flow state as “wired in”, or sometimes as The Zone, hack mode, or operating on software time when developing in an undistracted state. Stock market operators often use the term “in the pipe” to describe the psychological state of flow when trading during high volume days and market corrections. Professional poker players use the term “playing the A-game” when referring to the state of highest concentration and strategical awareness, while pool players often call the state being in “dead stroke”.

In the Workplace

Conditions of flow, defined as a state in which challenges and skills are equally matched, play an extremely important role in the workplace. Because flow is associated with achievement, its development may have specific implications for increased workplace satisfaction and achievement. Flow researchers, such as Csikszentmihályi, believe that certain interventions may be performed to enhance and increase flow in the workplace, through which people would gain ‘intrinsic rewards that encourage persistence” and provide benefits. In his consultation work, Csikszentmihályi emphasizes finding activities and environments that are conducive to flow, and then identifying and developing personal characteristics to increase experiences of flow. Applying these methods in the workplace can improve morale by fostering a sense of greater happiness and accomplishment, which may be correlated with increased performance. In his review of Mihály Csikszentmihályi’s book “Good Business: Leadership, Flow, and the Making of Meaning,” Coert Visser introduces the ideas presented by Csikszentmihályi, including “good work” in which one “enjoys doing your best while at the same time contributing to something beyond yourself.” He then provides tools by which managers and employees can create an atmosphere that encourages good work. Some consultants suggest that the experience sampling form (EMS) method be used for individuals and teams in the workplace in order to identify how time is currently being spent, and where focus should be redirected to in order to maximise flow experiences.

In order to achieve flow, Csikszentmihályi lays out the following three conditions:

  • Goals are clear.
  • Feedback is immediate.
  • A balance exists between opportunity and capacity.

Csikszentmihályi argues that with increased experiences of flow, people experience “growth towards complexity”. People flourish as their achievements grow and with that comes development of increasing “emotional, cognitive, and social complexity.” Creating a workplace atmosphere that allows for flow and growth, Csikszentmihályi argues, can increase the happiness and achievement of employees. An increasingly popular way of promoting greater flow in the workplace is using the “serious play” facilitation methods. Some commercial organisations have used the concept of flow in building corporate branding and identity, for example, The Floow Limited, which created its company brand from the concept.


There are, however, barriers to achieving flow in the workplace. In his chapter “Why Flow Doesn’t Happen on the Job,” Csikszentmihályi argues the first reason that flow does not occur is that the goals of one’s job are not clear. He explains that while some tasks at work may fit into a larger, organization plan, the individual worker may not see where their individual task fits it. Second, limited feedback about one’s work can reduce motivation and leaves the employee unaware of whether or not they did a good job. When there is little communication of feedback, an employee may not be assigned tasks that challenge them or seem important, which could potentially prevent an opportunity for flow.

In the study “Predicting flow at work: Investigating the activities and job characteristics that predict flow states at work”, Karina Nielsen and Bryan Cleal used a 9-item flow scale to examine predictors of flow at two levels: activity level (such as brainstorming, problem solving, and evaluation) and at a more stable level (such as role clarity, influence, and cognitive demands). They found that activities such as planning, problem solving, and evaluation predicted transient flow states, but that more stable job characteristics were not found to predict flow at work. This study can help us identify which task at work can be cultivated and emphasized in order to help employees experience flow on the job. In her article in Positive Psychology News Daily, Kathryn Britton examines the importance of experiencing flow in the workplace beyond the individual benefits it creates. She writes:

“Flow isn’t just valuable to individuals; it also contributes to organizational goals. For example, frequent experiences of flow at work lead to higher productivity, innovation, and employee development (Csikszentmihályi, 1991, 2004). So finding ways to increase the frequency of flow experiences can be one way for people to work together to increase the effectiveness of their workplaces.”


Positive Experiences

Books by Csikszentmihályi suggest that enhancing the time spent in flow makes our lives more happy and successful. Flow experiences are predicted to lead to positive affect as well as to better performance. For example, delinquent behaviour was reduced in adolescents after two years of enhancing flow through activities.

People who have experienced flow, describe the following feelings:

  1. Completely involved in what we are doing – focused, concentrated.
  2. A sense of ecstasy – of being outside everyday reality.
  3. Great inner clarity – knowing what needs to be done, and how well we are doing.
  4. Knowing that the activity is doable – that our skills are adequate to the task.
  5. A sense of serenity – no worries about oneself, and a feeling of growing beyond the boundaries of the ego.
  6. Timelessness – thoroughly focused on the present, hours seem to pass by the minute.
  7. Intrinsic motivation – whatever produces flow becomes its own reward.

However, further empirical evidence is required to substantiate these preliminary indications, as flow researchers continue to explore the problem of how to directly investigate causal consequences of flow experiences using modern scientific instrumentation to observe the neuro-physiological correlates of the flow state.

Positive Affect and Life Satisfaction

Flow is an innately positive experience; it is known to “produce intense feelings of enjoyment”. An experience that is so enjoyable should lead to positive affect and happiness in the long run. Also, Csikszentmihályi stated that happiness is derived from personal development and growth – and flow situations permit the experience of personal development.

Several studies found that flow experiences and positive affect go hand in hand, and that challenges and skills above the individual’s average foster positive affect. However, the causal processes underlying those relationships remain unclear at present.

Performance and Learning

Flow experiences imply a growth principle. When one is in a flow state, they are working to master the activity at hand. To maintain that flow state, one must seek increasingly greater challenges. Attempting these new, difficult challenges stretches one’s skills. One emerges from such a flow experience with a bit of personal growth and great “feelings of competence and efficacy”. By increasing time spent in flow, intrinsic motivation and self-directed learning also increases.

Flow has a documented correlation with high performance in the fields of artistic and scientific creativity, teaching, learning, and sports.

Flow has been linked to persistence and achievement in activities while also helping to lower anxiety during various activities and raise self-esteem.

However, evidence regarding better performance in flow situations is mixed. For sure, the association between the two is a reciprocal one. That is, flow experiences may foster better performance but, on the other hand, good performance makes flow experiences more likely. Results of a longitudinal study in the academic context indicate that the causal effect of flow on performance is only of small magnitude and the strong relationship between the two is driven by an effect of performance on flow. In the long run, flow experiences in a specific activity may lead to higher performance in that activity as flow is positively correlated with a higher subsequent motivation to perform and to perform well.


Csikszentmihályi writes about the dangers of flow himself:

…enjoyable activities that produce flow have a potentially negative effect: while they are capable of improving the quality of existence by creating order in the mind, they can become addictive, at which point the self becomes captive of a certain kind of order, and is then unwilling to cope with the ambiguities of life.

Further, he writes:

The flow experience, like everything else, is not “good” in an absolute sense. It is good only in that it has the potential to make life more rich, intense, and meaningful; it is good because it increases the strengths and complexity of the self. But whether the consequence of any particular instance of flow is good in a larger sense needs to be discussed and evaluated in terms of more inclusive social criteria.

Keller and Landhäußer (2012, p.56) advocate for a flow intensity model because many models of flow have trouble predicting the intensity of flow experiences that can occur under various circumstances where skill and task demands fit together to produce flow.

Cowley et al. found that because self-reported flow happens after-the-fact, it does not really capture the aspect of flow that happens in the moment. Furthermore, that aspect of flow is prone to change, so the self-reported experience of flow cannot be trusted as much.

Cameron et al. found that there is not a lot of information on group flow, and this may be hindering development in managerial and theoretical contributions.

Future Directions

Cameron et al. proposed a research program that focuses on how group flow is different from individual flow, and how group flow affects group performance. These ideas will address some of the issues in group flow research such as poor data collection and interpretation.

Sridhar & Lyngdoh suggested that research should investigate how mobility affects the ethical performance of sales professionals. Furthermore, there should be longitudinal studies done in various fields to understand the ethical implications of flow in sales.

From their study, Chen et al. found that there needs to be more research done on how competition affects game-based learning.

Linden et al. suggest that a neuroscientific model of flow would lead to new research questions that would guide future discoveries, experiments, and less obvious questions.

Thissen et al. propose that more research is recommended in 2020 to understand how traffic affects fiction reading for all types of readers.

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What is the European Federation of Psychology Students’ Associations?


The European Federation of Psychology Students’ Associations (EFPSA) is a not-for-profit, non-governmental student organisation that consists of psychology student associations from across Europe. EFPSA currently consists of 33 Member Organisations and two Observer Organisations, each represented by a Member Representative, who collectively form the legislative body of the Federation.

The work of the Federation is perpetuated through the work of the Member Representatives (MRs), the Executive Board (EB) and the Board of Management (BM). EFPSA provides psychology students with diverse opportunities for scientific- and self-development through its Events and Services. Additionally, EFPSA also aims to contribute to a positive impact in society through a variety of campaigns while representing the interest and needs of psychology students on a European level.

Brief History

EFPSA was founded in April 1987 at the University of Lisbon, Portugal where European psychology students from all over Europe had been invited to a meeting. Psychology students from eight European countries formed the European Federation of Psychology Students’ Associations (EFPSA).

The basic outlines of this Federation were transformed into formal statutes during the second meeting in Liege, Belgium in April 1988. At the same time, EFPSA initiated its first project, the EUROPSYCHO-Database on education and exchange. In January 1989, EFPSA was registered as an international association according to the Belgian law.

During the third General Assembly in April 1989 in Lund, Sweden, the Federation developed its initial structure with the first meeting of the Executive Board (EB) being held for the first time in that same year. In July 1991, EFPSA started a collaboration with the European Federation of Psychologists’ Associations (EFPA) in Amsterdam, the Netherlands, after which EFPSA became an official affiliate member of EFPA in 2001.

After EFPSA’s participation in the first European Student Conference (which brought together about 500 students from a number of disciplines) in Liege (Belgium) in November 1990, a lot of new contacts were made, especially with Eastern European countries. During the fifth General Assembly in April 1991 in Geneva (Switzerland) EFPSA grew to 11 member countries, and the first delegation from Eastern Europe was welcomed. In this year the idea of permanent working groups (called “task forces”) came into being to enable more efficient work on projects such as EUROPSYCHO, ERASMUS, etc. Over the years leading up to new millennium, more Events in the form of Summer Schools and seminars and, of course, the Congress were organised under the guidance of EFPSA. In 2006, EFPSA developed its Corporate Visual Identity and became recognised with its representative logo and orange colour.


The structure of EFPSA was developed at the third General Assembly in April 1989 in Lund (Sweden). At this time, members of the Executive Board also covered the functions that Member Representatives do now. There were no Board of Management positions, only a President. Since then, EFPSA has grown in size and had to implement some significant structural changes, creating a new form of Executive Board. In 2003, the concept of National Representatives (nowadays known as Member Representatives) was introduced. These formed the new decision-making body from each of the associations which were members of EFPSA. Furthermore, the Board of Management as a separate body within the Executive Board was formed due to the need for leadership on strategic decisions, as well as monitoring the efficiency of the whole organisation.


EFPSA currently organises eleven annual and one biennial event:

  • The Congress;
  • European Summer School (ESS);
  • EFPSA Academy;
  • Train the Trainers (TtT) Summer School;
  • Train Advanced Trainers (TAT);
  • Trainers’ Meeting (TRAM);
  • Trainers’ Conference (TRaC);
  • EFPSA Day; and
  • The Joint Executive Board & Member Representatives Meeting and Board of Management Meetings are the annual events, while the Conference is the biennial event.

European Summer School

The first European Summer School (ESS) took place in Leie, Estonia in 2007. with the topic ‘Cross-Cultural Psychology’ followed by European Summer Schools covering different topics each subsequent year. During this seven-day event students immerse themselves into a programme of intercultural research where they have the opportunity to join one of six research projects led by a PhD supervisor in planning and implementing a 12-month study. Apart from this, the programme is enriched by a variety of lectures given by professionals from relevant areas of psychology. Each year, all lectures and research are set against a theme, chosen to reflect a field of contemporary psychology. Since 2011, all ESS participants completing the training programme and committing to the research project have been invited to join the Junior Researcher Programme, extending the European Summer School from a one-week Event into a fully structured 12-month research programme.


EFPSA Day is a promotional event that takes place across Europe at the beginning of December. The first EFPSA Day was held in 2010. The aim of this one-day event is to spread the word about EFPSA all over Europe. Presentations, workshops and other activities connected with EFPSA take place in many universities on the same day in order to make as many students as possible familiar with EFPSA.

Train the Trainers

In 2010, the first Train the Trainers summer school took place in Austria.[9] The Train the Trainers (TtT) summer school is an annual seven-day event featuring experiential and non-formal education aimed at providing its participants with insights and tutoring on a broad set of skills and knowledge about delivering training and information. Upon completion of set requirements, the TtT graduates may be invited to join the EFPSA Trainers’ Pool – a supportive environment for furthering training skills and experiences.

EFPSA Conference

The EFPSA Conference first took place in Amsterdam, the Netherlands in 2013. The EFPSA Conference is a biennial event and places a particular emphasis on its scientific programme. It brings together around 150 students from all over Europe for four days of lectures, workshops and student presentations. During the Conference, there is an open day, which consists of approximately 30 students from the hosting country/region joining the Conference for one day, to get an opportunity to learn, partake in the lectures and network with the participants.

Journal of European Psychology Students

The Journal of European Psychology Students (JEPS) is a double-blind peer-reviewed open access academic journal run entirely by students, covering all aspects of psychology published by the EFPSA and Ubiquity Press since 2009. JEPS brings a legitimate opportunity for psychology students to consider their thesis or research with international scope. Submissions have to be based on research conducted by bachelor or master students who may also be from outside Europe. Authors of selected submissions will receive professional feedback and help in developing their scientific publication. Articles are selected based on quality of research alone, disregarding the perceived importance and originality of a particular paper. Articles are indexed in EBSCOHost. Since 2016, JEPS invites students to submit Registered Reports. The JEPS team also run a blog, the JEPS Bulletin, which has been publishing since November 2010 on a range of issues relevant to psychology students of all levels and varied fields of interest.

Member Organisations

Organisations from all countries recognised by the Council of Europe can become members of EFPSA. Organisations from countries/regions that are not recognised by the Council of Europe can be taken into consideration as Regional Members. As of April 2018, EFPSA has 33 Member Organisations and two Observer Organisations.

This page is based on the copyrighted Wikipedia article <https://en.wikipedia.org/wiki/European_Federation_of_Psychology_Students%27_Associations >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is the European Federation of Psychologists’ Associations?


The European Federation of Psychologists’ Associations is the umbrella organisation of national societies in the field of psychology that are located in the European Economic Area.

Refer to the European Federation of Psychology Students’ Associations (EFPSA).

Brief History

The federation was founded in 1981 and the first general assembly was held in Heidelberg. Since then, general assemblies have been held every two years in different European cities. Since 1995, the general assembly is held in conjunction with the biennial European Congress of Psychology.


The federation is concerned with promoting and improving psychology as a profession and as a discipline, particularly, though not exclusively, in applied settings and with emphasis on the training and research associated with such practice. Its official journal is the European Psychologist. In 2009, the federation launched the EuroPsy register.

Member Associations

As of July 2019 the federation has 39 member associations, which together represent over 350,000 psychologists from all 28 members states of the European Union. In addition, there are 11 organisations registered as associate member associations and 2 that are registered as affiliate member associations.


One of the major initiatives of the federation was the establishment of the EuroPsy or European Certificate in Psychology. This qualification sets a common standard for education, professional training and competence for psychologists to practice independently across Europe.

Aristotle Prize

The Aristotle Prize, established in 1995, is awarded by EFPA to a psychologist from Europe who has made a distinguished contribution to psychology.

Recipients of the prize have been:

  • 1995: Pieter Drenth.
  • 1997: Paul Baltes.
  • 1999: David Magnusson.
  • 2001: Alan Baddeley.
  • 2003: Lea Pulkkinen.
  • 2005: Rocio Fernandez-Ballesteros.
  • 2007: William Yule.
  • 2009: Claus Bundesen.
  • 2011: H. Marinus Van Ijzendoorn.
  • 2013: Niels Birbaumer.
  • 2015: José Maria Peiro.
  • 2017: CON AMORE – Centre on Autobiographical Memory Research.
  • 2019: Naomi Ellemers.

This page is based on the copyrighted Wikipedia article <https://en.wikipedia.org/wiki/European_Federation_of_Psychologists%27_Associations >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.